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The high-functioning alcoholic

By Deborah Goad

Nearly 14 million U.S. adults – one in 13 – abuse alcohol or are alcoholics, according to estimates by the National Council On Alcohol and Drug Dependence (NCADD).

Alcohol is the single most used and abused drug in America. Nearly 14 million U.S. adults – one in 13 – abuse alcohol or are alcoholics, according to estimates by the National Council On Alcohol and Drug Dependence (NCADD). Odds are you do or have worked or interacted with one.

While alcoholism causes economic harm to businesses estimated in the tens of billions of dollars annually, it poses a difficult management issue because it is an often imprecise disease condition that can be covered by the Americans with Disabilities Act.

Despite familiar stereotypes and media images such as the wobbling town drunk or the slovenly sodden neighbor, for many alcoholism is nearly invisible.

The drinker might not even know – or be in full denial about their condition. They can be responsible, hard-working and functioning well in most areas of their lives, yet chemically dependent. A surprising number are even top-achievers and hold high positions in their careers.

These people are referred to as high-functioning alcoholics (HFAs).

Rather than the classic signs and patterns, the issues and symptoms with HFAs often are well hidden. Though holding jobs and appearing “typical,” they do drink alcoholically, meaning their consumption is far above average. Many are able to avoid alcohol during the workday, yet consume large quantities in the evening.

Of the alcoholic population in America, it is estimated nearly 20 percent are HFAs. Getting them to recognize they are alcoholic is difficult because most are in denial and point to their careers or standing in the community as proof that they do not have a problem.

There are myriad reasons the HFA drinks, with stress prevalent in a large number of cases, according to experts. However, the outcomes are the same: health problems, turbulent relationships or eventual meltdowns.

Out of sight, but still troubling

Indeed, if the problems are invisible and job performance is average to well above average, then why be concerned? There are many reasons, experts say. Alcoholism rarely (if ever) decreases and typically can be counted on to continue to worsen. And as it does, performance does suffer or on-the-job behavioral issues do surface. It is, after all, a disease, and it erodes mental capacity, judgment and overall well-being.

As the individual’s career develops, he or she becomes more important to the company and usually is awarded more responsibility – while at the same time the disease gains a bigger foothold in their lives. A familiar pattern is that as the HFA individual continues to “climb the ladder,” the stress of new increased responsibilities on the job leads to an increasing dependence on alcohol outside of work.

Alcoholism progresses and increases like any disease, but often the HFA’s tolerance to alcohol likewise increases.

An HFA might consume as much as a stereotypical chronic “problem” drinker yet not appear intoxicated to the casual observer. They develop a tolerance that requires them to drink far more than average to feel any effects. This slow build-up of tolerance leads to drinking at levels that can result in organ damage, cognitive impairment and a profound alcohol dependence.

At some point, however, disease and consumption eclipse the ability to handle stress or workload, and performance does begin to suffer. Destructively, substance abuse experts report, the feeling of losing control or of “losing their edge” then pushes the high-functioning alcoholic to drink more and self-medicate in an effort to numb the emotional discomfort. With work and disease progressing in tandem, they reach a critical point in their inability to handle stress and their disease becomes unmanageable.

In the worst situations, serious health issues also occur.

Definitions, behaviors and solutions

HFAs usually are not viewed by society as “alcoholics” because the usual stereotypes don’t fit. According to research literature and other sources, about half are tobacco smokers and around one-third have a multigenerational family history of alcoholism.

Additionally, having one drink is nearly impossible because they crave more. Despite committing to themselves or others that they will only drink a certain amount, they cannot predict how much they will have.

Among the prevalent HFA behaviors:

• Using alcohol as a reward.

• Obsessing about when they will have their next drink.

• Staunch denial that their lives are unmanageable due to their drinking.

• Drunkenness prior to arriving at social events.

• Repeating uncharacteristic behaviors.

• Memory loss and/or blackouts.

• Attempt sobriety only to consume larger quantities upon resumption.

• Not being able to imagine their life without alcohol.

It is difficult to help or to effect change in these situations, according to substance abuse and human resource experts.

Many people tie much of their identity and self-esteem to their careers, thus most HFAs are very resistant to the suggestion they have a problem. Relative competence at work is wielded as a shield: “I don’t have a problem – look how well I do at work.”

Additionally, the high-functioning alcoholic can hit bottom in areas of their life, yet not recognize it.

Here are some job attendance and performance characteristics and behaviors can reflect likely alcoholism, although they are not definite proof. Individual indicators must be examined in light of a range of behaviors and symptoms, and no one item should be taken as a definite sign or diagnosis. They do merit closer monitoring and follow up for potential identification of a larger pattern and to make a better supervisory assessment.

Attendance issues supervisors should be alert to include:

• Unexplained absences from work.

• Frequent tardiness, especially after lunch.

• Numerous sick days.

• Frequent Monday absences.

• Frequent absences the day after being paid.

Performance issues supervisors should be alert to include:

• Missed deadlines.

• Careless work.

• Repeatedly missing production quotas.

• Faulty analysis and poor decision-making.

Although no one sign means that an employee is an alcoholic, when conduct and performance problems are mixed with multiple indicators, then it is time to enlist professional guidance. This includes human resources consultants, employee assistance programs, behavioral health facilities and other trained behavioral health professionals.

Given the nod to the Americans with Disabilities Act, employers should consider consulting with an employment attorney, too.

Helping them, helping your company

According to the NCADD, studies suggest that the cost of alcoholism in the workplace ranges from $33 billion to $68 billion per year, and that absenteeism among alcoholics is estimated to be four to eight times that of their sober coworkers – who in turn can end up resentful about having to perform their absent colleague’s work

It is easy to think HFAs pose danger only to themselves, yet they are one of the greatest dangers to employers; they present distinct liability issues inside and outside of a company beyond self-inflicted damage.

For instance, if an employee is involved in an accident involving non-employees, liability issues can be dire. Dangers to themselves and others in the workplace can be just as onerous, and vigilance in any case is important.

A complicating factor is that alcoholism is covered under the Americans with Disabilities Act, as outlined in this excerpt from “ADA Questions and Answers” by the U.S. Equal Employment Opportunity Commission and the U.S. Department of Justice: “… (A) person who currently uses alcohol is not automatically denied protection. An alcoholic is a person with a disability and is protected by the ADA if s/he is qualified to perform the essential functions of the job. An employer may be required to provide an accommodation to an alcoholic. However, an employer can discipline, discharge or deny employment to an alcoholic whose use of alcohol adversely affects job performance or conduct. An employer also may prohibit the use of alcohol in the workplace and can require that employees not be under the influence of alcohol.”

So, the question remains: How to handle an alcoholic in your workplace? If you think there is a real potential an employee or coworker is an alcoholic, the general best practice is to seek professional guidance in dealing with the individual. If this person is a good employee or is key to the company’s operation, an employer-sponsored treatment program could benefit them and you.

In that circumstance, there are means to monitor the progress of treatment.

“It’s very helpful when employees include their employer on a release-of-information form if they are referred for treatment or admit themselves,” said Jason Staats, director of outpatient and inpatient addictive diseases at The Ridge Behavioral Health System in Lexington. “This helps the employee stay in good standing at work by keeping the employer apprised of their progress and shows they are motivated to return to work.”

Treatment programs, such as those offered by The Ridge, offer a variety of options depending on the individual’s need. For instance, those who may experience withdrawal symptoms – because they have built up to very high usage levels – would benefit from an inpatient detoxification program. Besides the usual three-week inpatient stay for treatment, for those not requiring detox there are day or evening outpatient programs that allow the person to continue their employment.

Leslie Flechler, a spokesperson with Lincoln Trail Behavioral Health System in Radcliff, Ky., recommends that human resources personnel at the patient’s employer be included as eligible recipients of patient information on Health Insurance Portability and Accountability Act (HIPAA) release form.

“While too much HR involvement can be interpreted as intrusive,” Flechler said, “a caring attitude is helpful, and can help them get back to work more quickly.”

Preemptive and proactive

It is important for companies to have policies in place to deal with alcohol abuse, drinking on the job, confidentiality and referral sources. While it can be difficult to assess each case individually, there are many reasons to do so and then make a decision as to how to proceed. In any case, it is crucial to make it clear to all employees that substance abuse of any kind on the job is unacceptable. For those cases where the individual shows signs of an addictive disease, care should be taken to assess not only their condition but the options your company feels appropriate, based on their overall performance and their history and value to the company.

One resource for gaining more awareness is the National Council on Seniors Drug & Alcohol Rehab. 

Deborah A. Goad, MA, MS, LMFT, of Lexington has 25 years experience ranging from inpatient and outpatient clinical programs to individual substance abuse therapy.