Nowhere to Hide: High-Functioning Alcoholics Endanger Selves and Others

By Hugh C. McBride

On July 26, on the way home from a family camping expedition, Diane Schuler steered her Ford Windstar the wrong way onto the Taconic State Parkway. Less than two miles later, her vehicle slammed head-on into an SUV, killing her, four of the five children she was transporting, and the three men in the SUV.

Police initially assumed that Ms. Schuler had suffered from some type of catastrophic medical condition that resulted in such erratic, and eventually deadly, actions. But when authorities more thoroughly examined Ms. Schuler's body and the remnants of the vehicle she was driving, the evidence pointed in a different direction:

• At 0.19 percent, Ms. Schuler's blood-alcohol level was more than twice the legal limit.
• Ms. Schuler had six grams of undigested alcohol in her stomach when she died.
• Toxicology reports indicate that Ms. Schuler had also smoked marijuana within an hour of the accident.
• Police found a 1.75 liter vodka bottle in the wreckage of Ms. Schuler's minivan.

Though it doesn't take an expert to note Ms. Schuler's actions were dangerous, the Westchester County toxicology examiner described some of the impairments that such drug use would cause.

"She would have had difficulty with her perception, with her judgment and her memory," Betsy Spratt said in an Aug. 5 New York Daily News article. "Around that level of alcohol you start to get tunnel vision where you can't see peripherally all the time."

In the aftermath of the accident, Ms. Schuler's family members (especially her husband, Daniel) were subjected to significant criticism for allowing someone with such an obvious drinking problem to get behind the wheel. The family responded with what may be a stunning response: They said Ms. Schuler never abused alcohol or other drugs.

"I never saw her drunk since the day I met her," Daniel Schuler said. "She is not an alcoholic."

"I've never seen her drink; I've never seen her smoke," Julie Shaughnessy, a neighbor of the Schulers, said in an Aug. 4 Newsday article. "There has to be another explanation."

High Functioning and Hidden

Most Americans have abandoned the notion that alcoholism conforms to the disheveled, bumbling stereotype made famous by Otis the town drunk on the popular “Andy Griffith Show.” But most of us would likely assert that we'd be sure to notice signs of alcohol or drug abuse in someone we lived with or cared about.

The experts beg to disagree.

No one will ever know for sure if Diane Schuler did, indeed, have a problem with alcohol or any other drugs. But while some have dismissed her husband's assertions as evidence of either denial or downright lies, others have noted that many people have been able to hide alcoholism and drug addictions from their closest friends and family members.

In an Aug. 10 article on the MomLogic blog, clinical psychologist Dr. Michelle Golland described the hidden alcoholic as "a person who controls their drinking enough to live a functional life, and maintains a semblance of normalcy in their marriage, social and occupational worlds."

Sarah Allen Benton, a clinical psychologist and author of a book on the topic (as well as a recovering alcoholic herself), prefers the term "high functioning alcoholic," which she described in a March 31 entry in her blog on the Psychology Today website:

[A high functioning alcoholic, or HFA] is an alcoholic who is able to maintain his or her outside life, such as a job, home, family, and friendships, all while drinking alcoholically. HFAs have the same disease as the stereotypical "skid-row" alcoholic, but it manifests or progresses differently.

Many HFAs are not viewed by society as being alcoholic, because they have succeeded and over-achieved throughout their lifetimes. These achievements often lead to an increase in personal denial as well as denial from colleagues and loved ones.

HFAs are less apt to feel that they need treatment for their alcoholism and often slide through the cracks of the health care system, both medically and psychologically, because they are not diagnosed.

In a May 4 interview with Jane E. Brody of The New York Times, Ms. Benton said that the relative lack of attention paid to high-functioning alcoholism may be due to the fact that this form of the disease "is not one of obvious tragedy, but that of silent suffering."

How Bad Can It Be?

As Ms. Benton implies, hidden or high-functioning alcoholics may be able to convince themselves and others that they really don't have a problem because they are still able to maintain an appearance of competence. They pay their bills, maintain their personal relationships and haven't been fired from their jobs, so how bad could the problem really be?

In two words: very bad.

Deadly alcohol-related traffic accidents are among the most obvious disasters associated with high-functioning or hidden alcoholism, but other less perceptible (yet very real) damage can also result:

• Health problems – Persistent alcohol abuse has been associated with a number of health concerns, including heart damage, liver problems, cognitive impairments and some types of cancers. Of course, alcohol abuse also significantly increases the likelihood that a person will be involved in an automobile accident or experience some other type of unintentional injury.
• Relationship problems – How healthy can their relationships really be if hidden alcoholics continue to go to great lengths to hide such serious problems from their partners?
• Career problems – Just like the people who mistakenly believe that they drive better after a few beers, anyone who thinks that their alcohol abuse is helping (or at least not hindering) their professional development is lying to themselves.
• Emotional and psychological problems – Some people begin to abuse alcohol as a means of self-medicating or numbing themselves from physical or emotional trauma; others find that their continued dependence (and the necessity of concealing their behavior from others) leads to depression, anxiety and other unhealthy mental states.

Dr. Mark L. Willenbring of the National Institute on Alcohol Abuse and Alcoholism addresses this matter in Ms. Benton's book, Understanding the High-Functioning Alcoholic.

“People can be dependent and not have abuse problems at all. They’re successful students. They’re good parents, good workers. They watch their weight. They go to the gym. Then they go home and have four martinis or two bottles of wine," Dr. Willenbring said. "Are they alcoholics? You bet.”

Women & Hidden Alcoholism

Hidden or high-functioning alcoholism can affect both men and women, but an Aug. 7 Associated Press article reported societal standards may cause women to take greater steps to hide their dependence upon alcohol or other drugs:

Women in particular feel an extra responsibility to keep their drinking secret, because they need to keep the family running smoothly, says Dr. Petros Levounis, director of the Addiction Institute of New York at St. Luke's-Roosevelt Hospital Center.
Because they hide it more often, frequently drinking alone, the problem is not only harder to spot but more acute when it is discovered.

"Women are often deprived of the normal red flags that the rest of the population enjoys," says Levounis, also a professor at Columbia University. "Men who work 9 to 5, they often come home late, and sloppy, and people notice. They may lose a job, but their lives are saved."

Because women are also at increased risk for certain alcohol-related effects, hidden alcoholism may have a particularly damaging effect on their lives and their health.

Help for the High-Functioning Alcoholic

Individuals who have successfully hidden their alcoholism, or who continue to function at what looks like a high level, need help and can benefit from professional treatment for alcohol abuse and alcohol dependence.

For alcoholics who are professionals (such as business leaders, doctors and lawyers), a luxury rehab facility or an executive rehabilitation program may provide the necessary level of care and discretion. For example, at Bayside Marin, a highly respected executive rehab program in the hills of Marin County, features include meals prepared by an executive chef, a luxurious setting in the mountains overlooking the beautiful San Francisco Bay and Mount Tamalpais, and the utmost in privacy and security -- all in addition to world-class medical services, addiction recovery support and related therapeutic care.

For women who have been struggling with high-functioning or hidden alcoholism, an alcohol recovery program for women may be the ideal resource. Focusing on the specific issues that affect female alcoholics, a women's rehab program such as The Rose of Newport Beach provides nurturing and supportive atmospheres in which recovering women can heal without the additional pressures that may accompany enrolling in a co-educational facility.

Regardless of the choice of recovery program, it is essential that even high-functioning alcoholics get the help they need to overcome their dependence. From minor setbacks to tragic accidents, even the most well-hidden alcoholism puts reputations at stake and lives in danger.