The Psychology of Denial: When High-Functioning Addicts Can’t See Their Addiction

It’s a familiar story for many who use drugs and alcohol: according to one NIAAA study, almost 20% of alcoholics belong in the “functional subtype,” a category that describes users who are able to manage their use in a way that limits the consequences to their work and personal lives. A far cry from the stereotypes we sometimes conjure up when imagining addiction, high-functioning addicts (or HFAs, as they’re called in psychology and addiction circles) are often successful executives with stable marriages and families who wouldn’t, under even the most liberal of definitions, consider their drug and alcohol use an addiction. “I was so high-functioning with a good job, a husband, and a big house that even if someone had come and told me I was an alcoholic, I wouldn’t have believed them,” said one woman who, when finally faced with the prospect of losing her job, eventually sought treatment.

For high-functioning alcoholics, it’s the ability to keep their drug and alcohol use separate from the other parts of their lives that enables them to deny that it’s a problem. They might think, If I were an addict, I couldn’t possibly be so successful at work. Or, My family would take me to task if they thought that I seriously had a problem. They rationalize the denial they have around their addiction by referring back to how functional they are (or at least appear to be).

It makes sense why they do so: many psychologists (Freudian and Freud-naysayers alike) consider denial a primitive defense mechanism that we use to protect ourselves (and sometimes the people around us) from emotional harm. It can also be a trauma response. For many, drugs and alcohol are a coping skill they use to deal with past trauma, and it can be terrifying to consider giving up the one thing that makes it possible for them to function. It can definitely be done, but it’s a process, one that comes with setbacks and triumphs alike. Whatever way you want to look at it, it’s understandable why people resort to denial. They want to protect themselves—and their families.

Eventually, though, most high-functioning addicts hit a wall (like the woman above) and realize that they need to seek treatment. That wall often appears when they recognize in themselves one of the following harbingers of addiction.

• They can’t stop drinking or using once they’ve started. They may even set limits (“I’ll have two drinks, and then that’s it,” or “I’ll just smoke one joint”) but they can’t stick to them, or they find it really hard to do so.
• They think about drinking or using—a lot. So much that it affects their ability to work, finish projects, or even spend time with friends. They might have a hard time imagining outings with friends that don’t involve drugs or alcohol (or skip them entirely because they’d rather be using or drinking).
• They make choices they wouldn’t make if they were sober. Maybe they find themselves engaging in sexually risky behavior when they normally wouldn’t, or they get behind the wheel of a car. In general, they take more risks. The important question is whether they feel guilty or embarrassed once they’ve sobered up—that’s usually a pretty good sign that their substance use is compromising their values.
• They find themselves repeating these patterns, even when they’d rather not. They may feel like they can’t control whether they use or not, or feel like using is inevitable, regardless of how hard they try not to, and regardless of how it affects the people around them.

When bringing these patterns up with loved ones, it’s important to remember that often, the best and most supportive thing you can do is to point them out. Accepting their addiction—the hard work, the “getting there”—isn’t something you can do for them, as much as you might want to. What you can do is be compassionate and supportive and patient, and remember that this is a journey—not a destination.