I Can’t Have A Problem With Drugs or Alcohol…

Even though stereotypes and stigma have been amended significantly, the ideas of who can be a person with a substance use disorder ** still outdated, limited, and provides “cover” to persons who are using defense mechanisms to avoid looking at their relationship with alcohol or drugs.

Below are 3 composite vignettes of people who are typical of clients that struggle with a substance use disorder.

“I can’t be an alcoholic, I’m a teacher.” 

Sarah is a seasoned teacher, and the team leader of her group. She knew from the time she was a little girl that she wanted to be a teacher. She’s been teaching 20 years, and unlike many of her early career peers, she has not wanted to leave the profession. She feels competent at work, parents like her, and students tend to ask her to write their teacher recommendation for their college application process. Sarah divorced 7 years ago, goes out with co-workers regularly and dates sometimes. She regularly gets together with her family who live nearby. She recently purchased her own home after a financial readjustment due to the divorce. Sarah’s 2 kids are now teens, and she enjoys the ways in which she can be more “hands off” and their increasing freedom as they drive and become more involved with school and work. Sarah has been known to “drink too much” at some informal work events, but that was a few years ago and she was going through the divorce. Her ex is clearly an alcoholic**, an engineer, and has gotten a DWI. Sarah is aware of how much he drank and her drinking doesn’t look like that. She comes home and most nights, pours a glass of wine. She tells herself and others that it is “a couple of glasses” but when she’s honest, she admits it is nearly all nights now and almost always more than 2 glasses. Sarah does not identify any negative consequences such as money issues, health issues, or legal issues. Sarah uses the defense mechanism of minimizing. 

“I have a stressful job. It’s pretty normal to drink the way I do.” 

Stan is an RN and works in a hospital in the Houston Medical Center. As an RN, he’s never been without a job. He works the night shift for the increased pay and enjoys close relationships with his co-workers. He gets home at 7:30 a.m. His wife has usually left for work, and he usually drinks 3-4 mixed drinks before being able to “wind down enough to sleep.” The overnight shift is challenging, but he and his wife have some financial stress and it pays more. It is difficult on the marriage and having to come home and sleep “right away” is elusive. Stan admits a growing uneasiness which he calls “situational” or “mild” depression and is considering seeing a Psychiatrist for meds. Stan does not think that alcohol is the problem; Stan thinks if he can treat the depression, the alcohol issue won’t be an issue. Stan uses the defense mechanisms of justifying, intellectualizing, and rationalization. 

“It’s one of my coping skills, but I have others.” 

Drew has been in law enforcement since completing his military service in his 20’s. Drew has been married 30 years and has 2 grown children. Drew enjoys his work – for the most part – but is tired of the politics involved. Drew attends church, is involved regularly in volunteer activities and has a hobby of fixing vintage cars. Drew used to exercise regularly but stopped after knee surgery and never returned to the habit. Drew’s wife went to work as a paralegal after the kids began school. Drew’s wife complains regularly about his drinking, but Drew tells her that he does not drink on the job, never had legal trouble, does not drink and drive, and his buddies do the same thing. Drew regularly points out the drinking of couples when they go out, and Drew looks forward to holidays and events where drinking is understandable and excused, such as 3-day weekends. Drew usually falls asleep in “his chair” and does not accurately recall how much he drank the night before. Drew drinks to manage stress.

 Substance Abuse, Misuse, and Addiction in Katy, Houston, and Texas

In my work with high functioning persons with an alcohol or substance use disorder, it has been demonstrated many times that substance use issues do not discriminate. As an illness, they can and do impact individuals across socio-economic, career, racial, spiritual, and all other demographic categories. Evaluating and treating these clients however, presents a unique challenge. 

1. The first challenge is that their lives serve to mask the severity of the illness. This allows the person with the disorder to “fly under the radar” and continue without glaring examples of consequences related to the misuse of alcohol or drugs. It also allows for family members and friends to have secondary denial * which removes a common factor in helping persons seek help; when persons important to the individual express concern. I wrote about this in the tug of war against addiction.
2. The second challenge is that maintaining that life becomes a barrier to treatment. What I mean is that the individual can’t conceive of a disruption to work, to relationship, income, productivity, or the general rhythm of their day. The idea of that disruption causes stress or anxiety which then triggers a perceived need for alcohol or drugs. 
3. The third challenge is that high functioning persons have often accomplished much using their skills, education, and experience. This tends to convince them that they can use those skills to change the relationship with alcohol or drugs, and/or intellectualize the illness which prevents them from considering it from the physiological standpoint and open to the need for treatment. 

How Being High Functioning Can Mask a Substance Use Problem

The other challenge I’d like to present in this post is that being high functioning can offer an “easy out” for the person with a substance use disorder – and their family members. This can happen while looking at other family members who have an identified problem. If that family member has obvious, or stereotypical, consequences of their drinking or use, the high functioning person can use that data as assurance that they are “ok.” Similarly, if the high functioning person or their family member does decide to attend a mutual help group such as AA or NA, they are likely to hear “stories” of other people’s experience that are dramatic. Stories that involve losing cars, marriages, destroyed credit ratings, crippling health problems, over-dosing, etc. can be exploited by the high functioning person as a defense mechanism to prove “I am not like them; I don’t have a problem.” They may literally think, like I wrote in this blog “I Not Like Those Other people.”

In fact, there are whole categories of thinking that are used to distance people from looking at their substance use disorder. They are called defense mechanisms. I wrote a series on defense mechanisms that you might find helpful.

It is often especially tricky to identify, evaluate, and treat substance use disorders in a high functioning individual. I encourage you to contact me to begin the process. I specialize in working with high achieving and high functioning persons with a substance use disorder.  

Each of the individuals featured above have a substance use problem that requires a thorough evaluation, a complete psych-social evaluation, and a custom treatment plan. 

*Secondary denial is when family or friends participate in defense mechanisms, protect the high functioning alcoholic/addict from taking responsibility for their illness, develop and offer their own reasons and excuses to minimize or explain the use.

**Since the start of this blog several years ago, I have been moving towards using person-first language and therefore away from using terms such as “alcoholic” and “addict.” There will be times, however, when research, other resources, and client vernacular uses these terms. Please understand that no disrespect is meant at these times. 

**Person-centered language note: As a leading clinician in substance use disorder assessment, treatment, and recovery, I am committed to elevating the language around mental health and substance use disorder. This means I will use “alcohol use disorder” rather than “alcoholic.” It means I will use “person with a substance use disorder” rather than “addict.” I minimize my use of the term addiction because it carries stigma, often people have their own relationship with the word accompanied with misinformation. I use the term recurrence or return to use rather than relapse. However, it’s important that people searching for help get connected with services that benefit them. In this regard, people are not searching “am I a person with a substance use disorder?” They are searching “am I an addict?” They do not search, “can a high functioning person have an alcohol use disorder?” They search “am I a high functioning alcoholic.” They don’t search “treatment for people who have a recurrence” but do search “how do I stop being a chronic relapser?” As such, I want to affirm people with substance use disorders with my care, which includes language but I also need to structure my business in a way that google searches find my material.