Although the term high-functioning addict insinuates that someone can abuse drugs or alcohol while balancing work or personal responsibilities, this is simply not true.
People who appear to be high-functioning may be hiding serious problems with alcohol or drugs, including prescription medications, which they take to enhance their performance or relax from stressful situations. They do not need to hit “rock bottom” before they experience suffering, and they can get help before the worst happens.
What Is a High-Functioning Addict?
You might struggle to moderate how much you drink but only after you get home from work. You might take medication to ease your back pain, but find that you need more of it throughout the day, when you do not feel physical pain. You may find that the idea of a family event draws you to a quick hit, but then you make your way through it feeling good.
These are all signs you might be a “high-functioning addict.” This is someone who meets the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) but is not struggling to meet professional or personal obligations.
The experience of being “high-functioning” is common among people struggling with addiction. No one hits “rock bottom” immediately, and in fact, many people who struggle with addiction start with what appears to be normal recreational use. They may feel that a quick joint, a pill, or a shot of liquor can ease stress and help them meet their obligations better, almost as though substance abuse enhances their performance in their daily lives.
Unfortunately, chemical changes in the brain lead to more frequent cravings, while a physical tolerance means the person takes more of the drug to get the original effects. This escalating abuse means someone who appears high-functioning will soon be unable to function.
The Signs of a High-Functioning Addict
Anyone who struggles with addiction will show signs of this problem, even if they otherwise appear to have their life in order. The DSM-5 lists four categories of symptoms related to substance abuse:
1. Impaired control: People with a high-functioning addiction probably struggle with controlling their substance consumption, but they may hide it from others. Signs of impaired control are:
- Using more of a substance than intended.
- Taking more of the substance more often than intended.
- Wanting to cut down on use but being unable to.
2. Social problems: If someone is considered to have a high-functioning substance use disorder, they may not have social problems that are immediately obvious. However, they may argue with their loved ones quite often while intoxicated. They may feel the need to drink or take drugs before a social event. Or, they may only go to social events where they are consuming drugs or alcohol.
Signs of social problems include:
- Neglecting responsibilities and relationships, even in ways that do not impair other responsibilities.
- Giving up activities they used to care about so they can abuse drugs or alcohol more often.
- Being unable to complete tasks at work, school, or home due to substance abuse.
- Struggling with being sick often after abusing drugs or alcohol, which impairs going to work or school.
3. Risky use: People who appear high-functioning engage in risky substance abuse patterns, with increasing doses and frequency of consumption. This is one of the biggest indicators of addiction, but people who appear high-functioning try to hide this from others.
- Using drugs in risky settings, including at social gatherings.
- Ongoing use despite consequences to physical, mental, and social health.
4. Physical dependence: As substance abuse escalates, the person may begin to feel like they need to abuse drugs or alcohol to feel normal, not just to feel good. They may believe that their substance misuse contributes to higher quality work, better social experiences, or greater relaxation. Unfortunately, this is a sign of dependence.
- Needing larger doses to get the original effects.
- Experiencing withdrawal symptoms or illness when the substance is not used.
The DSM-5 notes that there are three clinical levels of severity for substance use disorders: mild, with between one and three symptoms noted; moderate, with four to five symptoms diagnosed; and severe, with six or more symptoms above diagnosed. People who are high-functioning may have severe substance use disorder, but they try to hide their problem from loved ones or acquaintances.
Substances that may be abused include the following:
- Nicotine or tobacco
- Cannabis or marijuana
- Opioids, including prescription pain medication
- Depressants, including prescription anti-anxiety medication
- Stimulants, especially cocaine or amphetamines like Adderall
- Hallucinogens, including mushrooms or LSD
Prolonged consumption of these drugs at increasing doses indicates worsening addiction. People who seem to be high-functioning might actually struggle with intense cravings and dependence on drugs or alcohol and need help.
High-Stress Jobs & High-Functioning Addicts
One of the biggest problems with the term high-functioning is that, for too many people, it refers only to their jobs. While people struggling with addiction lose friends, party too hard, ignore their family, or skip out on personal responsibilities, they work harder than ever at their jobs to appear competent. They may enjoy their jobs, but they may also work too hard to prove that they are not suffering — that taking drugs makes them better at work or that it helps them relax after a stressful day.
Many high-pressure jobs are associated with high rates of substance abuse and addiction. For some, seeking out this type of work gives them access to drugs that lead to abuse. For others, substance abuse is associated with higher rates of stress and mental health disorders from working too hard.
Here are the jobs most associated with drug or alcohol abuse and the rates at which people struggle with addiction in those positions:
- 19 percent of construction trades or extraction workers
- 6 percent of service occupations
- 9 percent of transportation and material moving workers
- 4 percent of sales
- 13 percent of entertainment, media, sports, and communications
- 11 percent of executive, financial, and managerial workers
- 6 percent of office and administration workers
Getting Help for Someone You Love Who Struggles With Addiction
If you suspect someone you love struggles with a substance use disorder, encouraging them to get help seems like the obvious choice.
It is important to offer support and express concern for people who struggle with addiction, but someone who appears high-functioning could be in denial that they have a problem. Simply saying that you think the person needs help could backfire, but so could staging a large intervention with lots of friends or family.
Still, finding a way to bring it up and offer your support for treatment is important. Psychosocial support, from loved ones and the surrounding community, can show someone who is “high-functioning” that they do not need to remain in denial. They do not need to lose their jobs, their friends and family, or other aspects of their lives before they get treatment.
- Inside the Secret Lives of Functioning Heroin Addicts. (February 2018). CNN.
- “High-Functioning Addicts”: Intervening Before Trouble Hits. (January 2014). CMAJ.
- DSM-5 Criteria for Addiction Simplified. (August 2020). Addiction Policy Forum.
- DSM-5 Criteria for Diagnosis of Opioid Use Disorder. (2013). American Psychiatric Association.
- Substance Use Disorders by Occupation. National Safety Council (NSC).
- What Is Rehabilitation? An Empirical Investigation Leading to an Evidence-Based Description. (February 2020). Clinical Rehabilitation.