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A question that’s frequently posed is whether people can be high functioning alcoholics and that’s a tricky question because there’s no clear criteria that we use to say someone’s high functioning versus low functioning. Often, people have stereotypes of what an alcoholic is and I think when people think of a high functioning alcoholic, it’s often because of those stereotypes and often the stereotypes are of the person stumbling down the street or the person who’s kind of who we used to call a bum who’s dirty and disheveled but often what we have is people who are alcoholic or who have alcoholic problems who really are, they still have families, they still maintain their jobs and they may in fact have very high level jobs. So what does that mean? How is that person considered to have an alcohol problem? Well, it goes to what the criteria is for an alcohol use disorder. So I’ve worked with many people over the years who fit into that category, are extremely high functioning people in their lives but usually what you start seeing is some deterioration in some part of their lives. They often are drinking much more than they think they are and often what they do is they also hide their drinking. They may drink quite “normally.” In other words, they may go out to – they may have work functions in which they control their drinking. They may drink exactly as other people are drinking. In fact, that’s often what happens is that people will look around them at their context, their social context and if people are having just one or two glasses of wine, they’ll have one or two glasses of wine. That’s what they’ll do so as not to draw attention to their drinking but if people are kind of drinking more heavily, they’ll go right along with the crowd. But again, if they have one or two glasses of wine, what they’ll do is they’ll go home and when they’re alone, they’ll continue drinking to get that desired affect of being inebriated whereas the other people would go home and go to bed. The other thing they may do, again, they’ll hide their drinking so they may often impose rules upon themselves where they’ll never drink before 5:00, they won’t drink at lunch, the three martini lunch that we used to hear about a lot, it doesn’t happen in that many contexts anymore but it does in some. There may be the people who travel, the executive who travels a lot who may drink on a plane and maybe get drunk but go to sleep and then be fine for when they’re at their business meeting. Again, really hiding their drinking. We particularly see hidden alcohol problems in women more so than in men and that’s a lot about social contexts and social stigma that is different for women than for men.
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