People who struggle with high-functioning addiction present with many unique treatment challenges and this requires a particularly nuanced approach to drug rehabilitation.
A program that has options to work with the unorthodox realities of high-functioning addiction offers the best chance of effectively treating people with this form of addiction.
The term high-functioning addiction refers to a person struggling with an addiction to one or more chemical substances which is still able to carry on parts of their life with seeming normality, even excellence.
To understand how this works, it is necessary to understand that addiction is not always a straightforward process of compulsion, consumption, and consequence. Everything — environmental factors, mental health, family history, age, and sex — can change how a person responds to the presence and temptation of alcohol or drug use.
Most people will likely suffer under the influence of too much alcohol, for example, but the National Institute on Alcohol Abuse and Alcoholism writes that 20 percent of people who drink too much hold down steady jobs, have college degrees, and maintain a stable family.
This may not sound problematic, but regardless of how well a person who is struggling with addiction functions, there is still an addiction at play. People who would meet the criteria for a high-functioning addiction will exhibit some behaviors that are characteristic of typical forms of addiction.
It can be challenging to see the signs of a functional drug habit because the person struggling with the addiction is usually very good at using their professional and personal accomplishments to hide the reality of the situation.
It might also be the case that some people with a high-functioning addiction problem are truly unaware that their substance use has become compulsive because of how good they have become at balancing their outward-looking life and their inward-looking psychological dependence on drugs or alcohol. Even when the withdrawal symptoms kick in, they are so good at powering through the distress and pain that they further convince themselves they don’t have a problem.
The 20 percent figure reported on by the National Institute of Alcohol Abuse and Alcoholism has led to a misconception that it is only alcohol abuse that is capable of creating people who struggle with high-functioning addiction. In truth, almost any substance capable of causing psychological dependence can lead to a person dealing with a form of high-functioning addiction.
For example, The New York Times writes of white-collar employees, driven to working 24/7 in unforgiving industries, surviving on diets of caffeine and chemical stimulants (cocaine, methamphetamine, and Adderall) to meet deadlines and make it to the office after pulling an all-nighter. Celebrity chef Gordon Ramsay told The Guardian that many workers in the hospitality industry turn to cocaine to help them keep up with the pressures of industrial kitchens.
Whatever the industry, there is a significant toll on mental and physical health when employees fuel themselves with drugs, but this contributes to the “work hard, party hard” image that people with high-functioning addiction strive to maintain.
On the inside, they are psychologically dependent on their stimulants to make it through another grueling workday. On the outside, they are financially successful, burning the midnight oil, and set for a rapid ascent up the corporate (or kitchen) ladder.
A characteristic of people struggling with high-functioning alcoholism is that they can hide many of the negative effects of their drug abuse, even though they use those drugs at rates that meet the criteria for a substance abuse problem. This can make treating people with this form of addiction very difficult, as they are often able to deflect any concern by pointing out the lack of evidence of a problem or by drawing attention to their successful lives. Additionally, these kinds of people are good at limiting their substance use and abuse to very specific times, but often, they are consuming drugs at extreme rates during these times.
The illusion of control is the key element for a person with high-functioning drug addiction. However, it is only an illusion. Everything they actively and passively do to continue and conceal their addiction falls under the diagnostic criteria of substance abuse.
Despite this, people who struggle with high-functioning addiction are so good at covering up their abuse that doctors can be unsure of identifying the disorder because it does not match the immediate signs of an addiction. A person with high-functioning alcoholism, for example, will likely not drink every day, nor will they be physically dependent on alcohol. Instead, they are psychologically dependent on alcohol, and they will not respond well to a rehabilitation program that cannot meet them at this level.
People who have high-functioning addiction have more barriers to treatment and treatment challenges than those who have “lower-functioning addiction.” If a treatment program tries to talk with them about repairing their personal or professional life, that kind of “leverage” won’t work. But it will offer a chance to engage them in a discussion about the stereotypes of people struggling with drug addiction and how people exist outside the stereotype.
For a drug rehabilitation program to make an impact on someone who has high-functioning addiction, it would have to employ a combination of psychology and education. The education would primarily center around challenging the stereotype of the “skid row addict” (primarily defined by poverty and homelessness). Instead, the focus would be on the fact that a majority of people who are addicted are high-functioning. This entails breaking the truth of addiction down and giving the person space to realize that addiction is not about how their life appears on the outside but instead about how their relationship with their drug of choice is inherently unhealthy and ultimately damaging.
Psychology Today notes that people struggling with high-functioning addiction are typically in deep denial about their problem. While denial is a characteristic of most forms of addiction, it is exceptionally the case for high-functioning substance use. For that reason, a drug rehab program should work hard at establishing a deep rapport and trust with the person, letting them know that they can discuss their issues with substance abuse at any time, and the program will be there for them. Pushing too hard will often increase the denial and increase substance use.
Giving the person space to come to the table is often the best way to induce a person with high-functioning addiction to accept the need for treatment. This kind of drug rehab should be an option for them. Once this connection has been made, identifying connections between the drug use and life’s difficulties will be productive.
People who present with high-functioning addiction usually discuss issues that they do not think are the results of their drug use. These include insomnia, mood imbalances, or other seemingly peripheral problems. A side effect of having a high-functioning addiction is the inability to draw a line from drug use to these issues. A drug rehab program that works with high-functioning addiction should be aware of this possible pathway to addressing the person’s deeper problems.
Control is key to the mechanics of a person dealing with high-functioning addiction, and many people in that position will try a number of different methods to cut down on their drug use. They might do it only on weekends, avoid “hard drugs,” or go without drug use for weeks or even months. However, they still have a psychological dependence on these substances and will inevitably go back to using.
A drug rehab program should be aware of the true nature of these efforts. It is important to explain to such clients that if they have to work so hard at controlling something, it is already out of control. Offering this perspective can be what alerts a person with high-functioning addiction that they are not as on top of their habits as they like to think.
One way to treat people suffering from high-functioning addiction is to use the mechanics of the addiction against itself. Such people tend to be very goal-oriented for obvious reasons, so an effective drug rehab program can use the strategy of mutual goal-setting to induce the person to collect irrefutable evidence that they do not have the control over their drug use that they insist they do. The key is to make clients come to their own conclusions about the reality of their drug use.
This can be done by establishing clear moderation goals, such as agreeing on a goal of limiting drug use to only certain days a week. It is vital to have a tangible agreement of these goals, such as putting them in writing and then track the person’s progress in following sessions. If a person really has high-functioning addiction, they will eventually fall short of these goals, which opens the door to accepting the need for further treatment.
It is possible that someone dealing with high-functioning addiction does not need to be admitted to an inpatient program. If this is the case, lower levels of care like outpatient therapy can be made available to streamline the process and appeal to the person’s need to be in control.
A drug rehab program that offers peer-led support group meetings might introduce the client to other people with high-functioning addiction who made the same assumptions and mistakes. In this way, a carefully constructed treatment program can break down the walls and illusions that most people with high-functioning addiction create for themselves.
It is essential for a drug rehab program for people with high-functioning addiction to offer their clients an additional support system. People struggling with this form of addiction have unique needs and concerns relating to their substance abuse, and many of the traditional models of treatment will be ineffective or even harmful. Giving such clients a second layer of rehabilitation — like individual therapy, group therapy, peer support, family therapy, or treatment with medication — increases the chance that they will better facilitate the necessary changes in their lives.
People who have high-functioning addiction typically report negative emotional and physical feelings during the early phases of their sobriety — something they might see as a form of “rock bottom.” A common complaint is that they struggle to handle their professional and personal responsibilities without drinking. Conversely, many people who present with lower-functioning addiction tend to report that their relationships and life situations take a turn for the better after treatment.
People in a drug rehab program for high-functioning addiction will need constant reassurance that their early struggles with sobriety are a natural, evolving part of the journey of recovery. These difficulties are not a reason to resume their addiction. Sometimes, things get worse before they get better, and that is part of the recovery process.
A good drug rehab program for people struggling with high-functioning addiction will give clients space to express the pain of that growth instead of expecting them to respond to treatment methods in the way people with lower-functioning addiction would. Clients can then experience the benefits of this specialized recovery, which is very effective in inspiring hope.
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