Treatment for a Functional Alcoholic
Numerous attempts have been made to identify and classify different subtypes of individuals who abuse alcohol. A frequently cited article from the journal Drug and Alcohol Dependence, published in 2007, used a sophisticated statistical technique known as latent class analysis to classify different types of alcoholism. This was based on a sample of 1,484 respondents to the National Epidemiological Survey on Alcohol and Related Conditions who met the diagnostic criteria for alcohol dependence (a diagnostic category that is no longer in use).
The researchers based their classification on the individual’s family history of alcohol use and abuse, the age of onset of their alcohol dependence, the presence of co-occurring psychiatric conditions and substance abuse issues, and their profile according to the diagnostic criteria from the DSM-IV (since replaced by the newer and updated version, the DSM-5).
These types of statistical models produce different models and classifications, but the researchers determined that the best model identified five different classes of individuals with alcohol dependence, now termed alcohol use disorders. One of the five subtypes of alcoholism (alcohol dependence) that was identified in the model was the functional alcoholic class.
What Is a Functional Alcoholic?
The latent class analysis model indicated that 19 percent of the individuals in the sample were classified in the functional alcoholic subtype. This figure is often mistakenly quoted as being that 19 percent of all individuals with alcohol use disorders (alcoholism) are functional alcoholics. However, that type of generalization is inappropriate as the method to procure the participants for the research does not allow for it.
Individuals classified as functional alcoholics by the research often behave in a manner that is in direct opposition to the common or stereotypic notions that people have about individuals who have alcohol use disorders. In addition, the notion of the functional alcoholic subtype has actually been around long before the latent class analysis model was developed, and it was based anecdotal observations. According to the book Understanding the High-functioning Alcoholic, which built on the basic factors identified in the latent class analysis model, high-functioning alcoholics have certain characteristics.
- They may be college educated, have partners or are married, and have jobs with relatively good salaries.
- They tend to restrict their use and abuse of alcohol to specific situations or times. This presents the illusion that they are in control of their alcohol use.
- These individuals are often able to convince others around them that their drinking is not problematic, but they still suffer from the effects of their substance abuse.
- They tend to minimize the problems associated with their abuse of alcohol.
- They often have a family member (e.g., a spouse) or friend cover for them when they have issues associated with their use of alcohol. One of the most common examples is having one’s spouse or another relative call in sick for them when they are hungover from a night of heavy drinking, or they may delay paying bills as a result of financial issues associated with their alcohol use.
- Individuals who are labeled as functional alcoholics often take the attitude that the issues they experience as a result of their alcohol abuse are “normal” for them. They are also able to convince others that their behaviors are normal for them as well.
- They often have some other co-occurring mental health issue, such as a major depressive disorder or anxiety disorder. As with their abuse of alcohol, they rationalize these co-occurring disorders as being normal for them and are able to convince others that these situations are normal for them as well.
- Functional alcoholics will often isolate themselves from other people in order to spend time alone drinking. Again, they are able to convince the people around them that this behavior is normal for them.
Can Someone Be a ‘High-Functioning’ Alcoholic?
It should be understood that anyone who meets the formal diagnostic criteria as described by the American Psychiatric Association (APA) for a substance use disorder, such as an alcohol use disorder (alcoholism), is experiencing significant distress and dysfunction as a result of their use of alcohol. The label functional alcoholic is meant to infer that the individual in this subclass actually violates many of the common expectations associated with individuals who have alcohol use disorders, but it is not meant to imply that the individual does not have a disorder.
The term functional alcoholic does not refer to any type of diagnostic category. It is instead a label based on a research study in an attempt to classify individuals with a specific type of substance use disorder. Even though the research study is often cited and has been updated, the five subtypes in the study have not been used in any diagnostic or classification scheme to identify alcohol abuse.
In addition, the current version of the DSM has significantly changed the diagnostic criteria for alcohol use disorders that were used in the study that identified these five latent classes of alcoholism (the criteria from the DSM-IV). New research using the updated diagnostic criteria could conceivably generate an entirely different classification scheme. For instance, in a recent study of college drinkers, a latent class analysis using DSM-5 diagnostic criteria in addition to other variables identified two classes of college drinkers.
The notion that an individual who meets the research classification of a functional alcoholic does not have a serious disorder is a myth. Several misconceptions that can be derived from the title of functional alcoholic are outlined below.
- Functional alcoholics do not have a problem with their drinking. By definition, anyone diagnosed with an alcohol use disorder has a problem with their use of alcohol.
- Functional alcoholics do not display symptoms of alcoholism. By definition, anyone with an alcohol use disorder must display the symptoms of the disorder.
- Functional alcoholics are in control of their use of alcohol. By definition, anyone with an alcohol use disorder suffers serious issues with controlling their use of alcohol.
- Functional alcoholics do not need treatment. By definition, anyone with any substance use disorder needs professional intervention.
Treatment for Functional Alcoholics
Individuals who might fall into the “functional” subclass of alcohol use disorders are often not readily going to admit that their alcohol use is problematic for them. In addition, these individuals often require corroboration from family members or friends (particularly spouses) to engage in their behavior. Some sources refer to these types of relationships as codependent relationships, although this is not a formal diagnosis but more of a descriptive term that is used to identify patterns of interaction that occur in individuals with dysfunctional relationships.
According to the book Substance Abuse and the Family, individuals who would be classified as functional alcoholics often develop serious issues in their relationships with their spouse, other family members, or friends that may result in them seeking treatment for relationship issues. A competent therapist will perform a complete assessment of the situation prior to engaging in any type of family or group therapy. Such an assessment should raise suspicions that the individual has a significant issue with their use of alcohol, and this should also be treated. In other cases, individuals with co-occurring mental health issues, such as depression or anxiety, may seek treatment for these issues, and the physician or therapist may be alerted to potential issues with alcohol abuse as a result of their assessment or ongoing treatment.
In cases where the person’s alcohol use disorder is not recognized as a result of being treated for some other issue, it is important the person is approached carefully regarding the need for treatment. Often, individuals with substance use disorders become very reactive to the notion that they have a problem that requires intervention, and they will attempt to rationalize their use of alcohol while at the same time devaluing the observations of others. A good strategy is to discuss the issue with a licensed mental health professional who specializes in the treatment of addiction before confronting the individual with a suspected alcohol abuse problem.
Perhaps the safest method of approaching someone with a suspected substance use disorder is to perform a substance use disorder intervention. A substance use disorder intervention is a method of attempting to get an individual into treatment, orchestrated by the person’s family members and close friends. While the intervention is organized by very close and concerned family members and friends, it should be supervised by a licensed mental health professional who specializes in the treatment of addictive behaviors or by a professional interventionist.
The intervention typically occurs after significant planning has taken place. The group plans and rehearses what they will say to the individual, and has a list of potential treatment providers for the individual to consider. The person with the suspected substance use disorder is asked to go to treatment immediately (during or after the formal intervention) or specific consequences will be put in place. These consequences vary depending on the situation.
Interventions are relatively successful in people getting into treatment. Those that focus on a non confrontational approach appear to be more successful in getting the individual into treatment than confrontational approaches. The success of the treatment depends on numerous factors; however, according to the National Institute on Drug Abuse, individuals who voluntarily enter treatment experience successful outcomes at nearly the same rate as individuals who feel they were forced to enter treatment. Thus, the use of a substance use disorder intervention may be one of the best options to get an individual who may be a functional type alcoholic into treatment.
Once the person is in treatment, other variables come into play regarding the outcome of the therapies used. To learn more about substance use disorder interventions and to find a professional interventionist, individuals can access the Association of Intervention Specialists.
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