High-functioning alcoholics and addicts are hard to get into treatment, and pose unique treatment challenges once they arrive. What makes the high-functioning addict so difficult to reach?
Challenge #1: Denial
Denial is perhaps the greatest obstacle to getting a high-functioning addict into treatment. High-functioning addicts are often intelligent and persuasive, characteristics that are used by the disease to justify maintaining their addiction. Because they do not fit the stereotype of a drug addict, feel that their lives are manageable, and haven’t hit “rock bottom,” many HFAs insist they do not need help.
David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine, and writes a blog about addiction. He is CEO of Elements Behavioral Health, a network of mental health and addiction treatment centers that includes a teen drug rehab at The Right Step and Promises young adult rehab.
Editor: Muhammad Talha
They lie, argue and manipulate their way out of addiction and rationalize their behaviors, often so effectively that loved ones and colleagues question their own observations.
Overcome it: It takes a skilled interventionist and experienced treatment team to help the HFA overcome their sophisticated system of denial and accept their powerlessness over addiction. An intervention allows the HFA to experience the full consequences of their behaviors and helps them understand the impact their addiction has had on the people closest to them.
In treatment, some of the ways we break through denial are:
• Psychoeducation about addiction, which helps the HFA understand what it means to be an addict – that it is not how their life appears from the outside but rather their dysfunctional relationship with drugs and alcohol
• Group therapy and 12-Step/SMART Recovery meetings, which allow HFAs to see their own patterns reflected in others and gain feedback from a peer rather than a treatment professional or authority figure
• Challenging irrational beliefs and cognitive distortions in one-on-one therapy, and pointing out consequences in a respectful, non-judgmental way
• Motivational interviewing, which can help the addict assess the costs and benefits of changing their behavior and come up with their own arguments for committing to recovery
• Experiential and holistic therapies, which can help the addict stop over-thinking and intellectualizing their problem and connect with their emotions
Challenge #2: Success/Ego
Narcissistic qualities and grandiosity are common among HFAs, who often feel different from or better than everyone else. Many HFAs perceive themselves as invincible and will go to great lengths to hide their addiction to avoid putting their career or reputation (and thus, their self-worth) in jeopardy. Because of the stigma of addiction, HFAs may believe that having a drug or alcohol problem and asking for help are signs of weakness.
Overcome it: At its core, ego is fear-based. In treatment, we address the underlying fears of failure and rejection as well as other limiting beliefs. Through education, group therapy and 12-Step/SMART Recovery meetings, HFAs get familiar with the ideas of surrender, humility and rigorous honesty and begin to realize that addiction is an equal opportunity destroyer – that it affects some of the world’s greatest thinkers and most successful professionals and entrepreneurs, who have also needed help to get well. Volunteer work is another great way to embrace humility and gratitude.
Challenge #3: Work Demands
Many HFAs hold careers in highly responsible positions. They refuse to commit to 30-plus days in drug rehab, arguing, “I can’t take time off work.” Many fear that admitting to an addiction will cost them everything they’ve worked so hard to achieve. Once in treatment, HFAs may still be focused on life outside of rehab rather than on the work of recovery.
Overcome it: Many employers are willing to support a talented employee through their recovery. The reality is that, without treatment, their job will not be there for long, and most of their colleagues are already aware that they have a drug problem. During rehab, fear of job loss or a damaged reputation can be used as leverage for committing to and completing treatment. In addition, some treatment centers work with professionals and executives to meet pressing career obligations during drug rehab so they are better able to focus on getting well.
Challenge #4: Entitlement
HFAs rest on their academic, financial and professional successes to justify continuing their addiction. They may argue, “I work hard, I deserve to have some fun.” Others may feel wronged by life and that they are owed of some type of reward or “pass” in the form of fast, predictable relief from emotional pain.
Overcome it: In treatment, high-functioning addicts learn healthier tools for managing stress, coping with difficult emotions and rewarding themselves, often through yoga, acupuncture, meditation, exercise and fellowship with others. Traditional and experiential therapies aid with accepting responsibility for their behaviors and connecting with the authentic self rather than blaming others.
Challenge #5: Enabling
Family, friends and colleagues of high-functioning addicts may unknowingly enable addictive behaviors. Some have the best of intentions, wanting to protect their loved one from harm or help them through a difficult time. Others may enable with self-interested motives; for example, an employee of a high-functioning addict may be concerned about the HFA but will continue to enable the addiction to preserve their own career.
Overcome it: The people closest to the addict often need treatment of their own to stop enabling. In therapy, they can learn to set boundaries and follow through on consequences. Groups like Al-Anon and Alateen can help family members understand the disease of addiction and how best to support themselves and the addict.
As many as 75 to 90 percent of addicts are the functional type, meaning a vast majority are resistant to getting help. But this does not mean they are hopeless. Although motivation may at first stem from external sources (an intervention by loved ones or the threat of job loss), motivation becomes internalized as the addict starts to feel better and build on their accomplishments. Once an HFA is invested in their recovery, the outlook for long-term recovery is bright.