The Myth of Being “High Functioning” in Addiction

March 23rd, 2022

A key function of National Drug and Alcohol Facts Week is to provide clear and concise factual information regarding drugs and alcohol to those who are curious and/or concerned about substance use. As a Certified Alcohol and Drug Counselor, I have witnessed how myths about addiction can often prevail over the truth. Part of the reason that myths about addiction become prevalent is that there is still a strong stigma regarding those who experience addiction.

When I ask people what they think about when thinking of someone who has a substance use disorder, it is likely that an image of someone like Rue fromEuphoria or Jackson Maine fromA Star is Borncomes to mind. Both of these characters struggle with addiction in a chaotic way.

In Euphoria we see Rue damage relationships, experience overdose, and risk her safety throughout her addiction to opiates while in A Star is Born we see Jackson Maine ruin relationships and swindle his career due to his problem with alcohol use. Both of these depictions of addiction are valid and real, however, they do not capture the experience of every person who has a substance use disorder.

This is where the myth of the “high-functioning addict” comes to the table. Someone who may think of themself as high functioning in their addiction may report that they are able to maintain their careers, responsibilities, and families while using substances maladaptively.

Often the ability to maintain these areas of life is why someone with addiction may not seek treatment. This might lead them to continue to use substances in a harmful way which can lead to lasting consequences. The chain of events I describe here is why I believe that the phrase “high-functioning addict” is harmful and is a myth that should ultimately be debunked.

What is Addiction?

Before discussing the issues with the phrase, “high functioning addiction,” I think it is first important to identify what it means to have an addiction. The following criteria as described in the DSM-5 are associated with a diagnosis of a substance use disorder:

Taking the substance in larger amounts or for longer than initially intended.
Wanting to cut down or cease using the substance but not being able to.
Spending significant time getting, using, and/or recovering from the use of a substance.
Having cravings and urges to use a substance.
Not managing to uphold responsibilities at work, home, or school due to substance use.
Continuing to use a substance even if the use is leading to relational problems.
Giving up valuable social, occupational, or recreational activities because of a substance.
Using a substance repeatedly, even when it put you in danger.
Continuing to use a substance even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
Needing more of the substance to get the effect you are seeking. This is commonly referred to as developing tolerance.
Development of withdrawal symptoms that can be relieved by taking more of the substance.

Someone who meets two criteria has a mild substance use disorder, someone who meets three to five criteria has a moderate substance use disorder and lastly, someone who meets six or more criteria has a severe substance use disorder.

I include the diagnostic criteria for substance use disorders because it communicates the wide variety of symptoms that can contribute to maladaptive substance use. As you can see, the only symptoms of addiction that are related to fulfilling responsibilities at work, home, or school are criteria number five, six, seven, eight, and nine. This means that someone could be managing each of those areas well and still meet the criteria for a severe substance use disorder.

This reality can be dangerous as there is an increased risk of numerous consequences to continued abuse of substances. Some consequences of maladaptive substance use include:

Negative impacts of the substance being used: For example, snorting cocaine can lead to damaged nasal passages, and using chewing tobacco can lead to oral cancer.
Injury: A common impact of substance use is having compromised balance and coordination which can lead to falls or other injuries.
Overdose: Many abused substances can lead to death if they are taken in too large of a quantity. Additionally, street drugs may be laced with more deadly substances like fentanyl.
Health complications: Prolonged substance abuse can lead to a compromised cardiovascular system which may lead to a stroke or heart attack.
Increased mental illness: Many substances interfere with the receptors in our brains that are responsible for emotions such as happiness and joy. This interference can lead the brain to not be able to produce the chemicals needed to feel these emotions which can lead to higher rates of mental illness.

How to Support Someone Who Is Struggling With Addiction

If someone believes that they are high functioning in their addiction, they may not have awareness of the above consequences. By not acknowledging these risks for those who are able to maintain responsibilities at home, work, and school while having a substance use disorder, we lose an opportunity to prevent greater suffering. If you believe that you or someone you love is “high functioning” in their addiction, it is important to seek support and treatment.

There are a variety of types of treatment and support for someone who has a substance use disorder. Below I will describe the various forms of help that are available:

Phone support: If you think you need support with your substance use, but are unsure of where to begin, the Substance Use and Mental Health Services Administration (SAMHSA) has a national helpline that you can call at 1-800-662-4357. They will guide you to resources based on the information you provide them.
Assessment services: By calling the SAMHSA helpline or a local treatment facility, a person will be able to speak to a trained assessment provider. This person will assess what level of care is needed based on the description of someone’s substance use
Medical and therapeutic treatment: Depending on the outcome of an assessment, a person is referred to a certain level of care. The levels of care in substance use from most restrictive to least restrictive are as follows: medically managed intensive inpatient services, residential services, partial hospitalization, intensive outpatient services, outpatient services, and early intervention.
Support groups: Support groups are typically a cornerstone for someone’s recovery. Some popular support groups in addiction recovery include 12-step programming, recovery dharma, and SMART recovery.
Caregiver support: Addiction not only impacts those using substances but also their support systems. Addiction can be difficult to understand and process. BC Centre on Substance Use has several resources for understanding and engaging with substance use disorders as a support member.

No matter how someone’s substance use disorder is presenting, they will likely need support and possibly treatment to find healing. Categorizing someone as “high functioning” may prevent them from seeking support which is a disservice to them and those who care for them.

Written By: Sarah Beerman, LCSW, CADC

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