AddictionThe notion of a “functional drug addict” is actually a contradiction of terms.
 
When anyone uses the term addiction or addict, they are referring to a serious issue with behavior that by definition implies some sort of dysfunction or disruption. Let us look at a few short definitions of the term addiction from professional societies that study, research, and formulate treatment approaches for individuals with addictions (now formally referred as substance use disorders):
The American Society of Addiction Medicine (ASAM) has a very long and formal definition of addiction on their website. The essential features of their definition of addiction are characterized by:

  • An inability to consistently abstain from using one’s drug of choice
  • Impairment in behavioral control
  • Significant craving for one’s drug of choice
  • Considerably diminished ability to recognize significant problems with one’s behaviors
  • Dysfunctional interpersonal relationships and a dysfunctional emotional response to the behavior
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    The American Psychiatric Association (APA) defines substance use disorders as formal mental disorders. A mental disorder is characterized by:

    • A clinically significant disturbance in an individual’s cognition (thinking)
    • A considerable disturbance in emotion regulation
    • Behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning
    • Significant distress that occurs in one’s social, occupational, or other important activities
    • As stated in every description of every diagnostic category in the current Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition, the behavior demonstrated by the disorder in question results in significant distress or impairment in the individual’s functioning.

    The National Institute of Health (NIH) defines addiction as a chronic, relapsing brain disease characterized by:

    • Compulsive drug seeking
    • Compulsive drug use
    • The person experiencing harmful consequences of this drug use

    Other national organizations such as the Substance Abuse and Mental Health Services Administration (SAMHSA) simply refer to organizations, such as ASAM or APA, regarding the definition of addiction.

    It is clear from the definitions of addiction (or substance use disorders as they are now formally called) from major national organizations that having an addiction must be associated with some form of dysfunction. Part of the issue with defining a functional addict is the mistaken notion that individuals who develop physical dependence on some drug or substance are “addicted” to the substance. This is a false assumption.

    Physical dependence consists of two components: tolerance and withdrawal. Tolerance occurs when an individual needs more of a substance to achieve the effects that were once achieved at lower dosages. A withdrawal syndrome occurs following usage of certain drugs for significant periods of time, as the individual’s system adjusts such that it can only function normally when the drug is present in its tissues. Once the levels of the drug in the tissues drop, the individual begins to feel negative physical and psychological effects.

    Addiction, as seen above, refers to a dysfunctional syndrome of behavior that results from nonmedical use of drugs and alcohol. A number of individuals are on medications that they use medicinally that produce physical dependence in them, such as individuals taking pain medication for chronic cancer; however, these individuals are not drug addicts according to formalized definitions. The symptoms of tolerance and withdrawal are potential symptoms of a substance use disorder; however, they are not sufficient for the diagnosis of a substance use disorder. Thus, having these symptoms alone may or may not be associated with the diagnosis of a substance use disorder.

    In addition, the use of the word functional is subjective and can be applied in a number of different contexts. A heroin addict who is able to satisfy their heroin addiction daily, live their life in relative squander, and make no known contribution to society, but reports relatively little discomfort regarding their addiction, would be defined as being functional under one set of circumstances or criteria, yet they would be described as being dysfunctional under a different set of criteria.

So What Is a Functional Addict?

First, there really is no such thing as a functional addict. By definition, individuals who have moderate or severe substance use disorders (addictions) have severe dysfunctions. It is probably far more accurate to designate between individuals with substance use disorders that are relatively high-functioning as opposed to using the fallacious term functional addict. Even in this context, the terms relatively high-functioning versus functional require quite a bit of subjectivity and are not defined in terms of clinical or even research criteria. Nonetheless, a number of individuals with moderate to severe substance use disorders do appear to be able to negotiate certain aspects of their lives while at the same time shielding many aspects of their dysfunctional behavior.

There are several descriptors to the notion of a high-functioning addict that can help to paint a picture of the issues involved as an individual negotiates life with their substance use disorder. A very good description of relatively high-functioning addicts comes from the books Understanding Why All Addicts Are Not Alike and Understanding the High-Functioning Alcoholic:

  • A good number of so-called high-functioning addicts are working, have fairly good incomes, tend to be college-educated, and tend to be partnered or married. They use their drug of choice at rates that would qualify them as having substance use disorders but are able to conceal many of the complications associated with their substance abuse.
  • These individuals are relatively successful (note the term relatively) at restricting their substance use and abuse to specific times or situations as opposed to appearing as if they are driven to use substances.
  • Their ability to restrict their use leads to the illusion that the person controls their substance use or abuse; however, this is not the case. Simply restricting use to specific times is not a disqualifying feature of having a substance use disorder and in fact is in line with the diagnostic criteria set forth by APA.
  • Despite being so-called functional or high-functioning addicts, these individuals still fail to maintain a number of responsibilities or personal commitments due to their substance abuse. However, they are able to minimize their failures to maintain certain personal commitments while maximizing the fact that their drug abuse helps them remain functional and cope with the pressures of life. The situation is often the ultimate hypocrisy.
  • High-functioning addicts will often engage friends or family members to cover up for them when they do experience issues with their substance abuse. For instance, an individual recovering from a long night of drug abuse may ask a spouse to call into work for them and say they are sick, or may hold off paying certain bills or do without certain accommodations as a result of financial issues associated with their substance use.
  • The friends and family members of high-functioning addicts simply rationalize the person’s behavior and fall into the trap that the situation is “normal” for them even though they recognize that it would not be normal for others.
  • High-functioning addicts tend to isolate themselves from other people and spend time alone using their substance as opposed to engaging in social activities or other commitments with family and/or friends. They are able to convince others that this type of behavior is normal for them.
  • The majority of relatively high-functioning addicts typically suffer from some other psychological disorder, such as depression, and they have convinced people close to them that these issues are just the “normal” state of affairs for them.

The illusion that relatively high-functioning addicts produce is that they are able to negotiate their behavior without significant ramifications; however, when their behavior and lifestyle is scrutinized, it is quite clear that they are experiencing significant areas of dysfunction in their lives even if they are able to negotiate other areas.

Most Relatively High-functioning Addicts Need Corroboration

treatment processGiven the above description, it is obvious that even though relatively high-functioning addicts attempt to promote the illusion that their behavior is within their control and it is “normal” for them, these individuals still have significant substance use disorders. One of the real issues is that many of these individuals have been able to convince others close to them that their disorder is “normal” for them and have been able to draw others into their own pathology. High-functioning addicts typically need others to buy into their presentation and support their own disorder by making others close to them part of the problem. The tragic part of this description is that by labeling someone as a functional addict or as a “relatively high-functioning addict, we normalize their behavior and become part of the problem instead of part of the solution. Just because an individual is able to continue to work at a relatively normal pace and able to appear to function in spite of their addiction does not mean that they do not have a serious problem.

Individuals labeled as relatively high-functioning addicts are not going to admit that they have an issue with drug abuse and are going to rationalize their behavior as something they need to do in order to be able to function normally. However, anyone who has a formal substance use disorder will experience severe ramifications associated with their behavior that would not be present if they were to stop their drug abuse.

People with substance use disorders or addictions are experts at manipulating other people. A term that has been used to denote the behavior of others who tend to foster and contribute to psychological disorders in people is codependency. This is not a formal clinical term, nor is it a formal clinical diagnosis; however, the term codependency does describe the situation where individuals have an excessive reliance on one another and tend to foster each other’s dysfunctional needs, psychological disorders, and even physical illnesses. Individuals in codependent relationships become fully enmeshed in the dysfunctional aspects of the relationship. They begin to rationalize these dysfunctional aspects and contribute to them. Relatively high-functioning addicts thrive on this type of situation.

Anyone who suspects that they, or another person close to them, have an issue with drug or alcohol abuse should seek a consultation with a professional and licensed mental health addiction specialist to determine if they could benefit from a professional assessment and/or professional intervention.