By Joel Lewin September 5, 2019
Most likely, you have heard the term “functioning alcoholic,” or “functioning addict”—someone who consumes improbable quantities of alcohol or drugs, but manages to competently fulfill their general work, life, and family obligations. Perhaps they even excel.
It is romanticized onscreen in shows like Mad Men, even given a certain glamour, an allure. Shenanigans are couched in terms of charming calamity. The term may be bandied about with bravado.
Importantly, distinctions are drawn with the “real” addict, who wakes up face down in a gutter outside the bar, or is shooting up on the street.
But maintaining this difference between a functioning addict and a regular addict can be harmful to a person who truly struggles with a substance addiction. The term can act as a barrier to someone deciding to get help. If my drinking or drug use isn’t causing too much harm, and if we’re all casually joking about it, is it really that big of a problem?
But although “failure to fulfill major role obligations at work, school, or home” and “persistent or recurrent social or interpersonal problems” are two of the criteria for substance use disorder in the psychiatric diagnosis benchmark Diagnostic and Statistical Manual of Mental Disorders, you don’t necessarily need to tick these boxes to qualify as a severe case.
At its core, addiction is inherently functional. Initially, the drug is not the problem. It is the solution to a problem. The addiction serves a function in the sense that it helps someone cope with something, often some kind of pain or distress, that may seem otherwise overwhelming.
While an addictive substance provides a tool to help someone function, a person who is addicted generally has a finite period of successfully functioning before things fall apart.
I remember the first time I took heroin at work. I was a trainee journalist at the time at the Financial Times. I had pitched a story about UK ports. The editor had saved a space on the page. But the further I dug into the story, the less writeable it seemed to be. I began catastrophizing, visualizing the next day’s paper wrecked with a salmon colored hole, (overlooking the fact there was probably a stack of other options they could choose from the day’s web content and the hold).
As time was ticking down, my anxiety levels rocketed, channeling years of neglected mental health issues. My thoughts became so scrambled I couldn’t think straight. I was having a meltdown. I went to the toilet and permanently erased a personal boundary: “Never at work.”
One line of heroin and the panic disappeared. I regained some clarity and pulled a story together in time.
The next few times I found myself struggling, I did the same. It seemingly worked wonders. I used before meetings to quell social anxiety. Gradually the threshold level of stress that merited the heroin treatment declined, and I was using all day, every day. But eventually it became a source of distress instead of a solution for stress.
And by then I was trapped.
The functional myth
There were periods when my addiction could actually make me seem more functional. My social, family, and leisure life were derelict, but I would spend hours at night pouring over data on the Bloomberg terminal, telling myself my life was rich in meaning despite my addiction because I was doing an interesting job.
Sometimes I spent all night wired, writing numerous stories which I would drop strategically throughout the day so my editor wouldn’t be suspicious as to when I had written all this copy.
The “functioning addict” idea can indeed fuel a lot of delusion. I used to convince myself opiates were performance enhancing for me to the extent I would look down judgmentally on colleagues who drank alcohol at lunch—“Don’t they consider the impact that will have on their work!?” Meanwhile, I’d just been taking heroin in the toilet.
A substance may be functional at first in the sense that it helps you cope. But the addiction is papering over the problem, which is growing and growing all the while. That’s partly why it can be so terrifying to quit—you are confronted with all the problems you tried to escape in the first place, many magnitudes greater by now, with your self-esteem in tatters. From this stems the belief “I can’t cope without it.”
Finally, all aspects of my life spiraled out of control. My performance plummeted, and progressive dysfunction set in.
The disconnect
Sometimes people cling to a romanticized idea of the functioning addict, the creative genius, etc. But the reality is most people’s output slides in quantity and quality as their addiction progresses.
Perhaps “still functioning addict” would be more appropriate. Often, it’s only a matter of time before the dysfunction creeps in.
And in any case, functioning in the world involves more than just getting the job done or ticking off a to-do list. It means being part of a team or a community, and addiction is not really conducive to teamwork. If your substance trumps your own needs, it definitely trumps those of your friends, peers, and loved ones.
In active addiction, it’s like you’re moving on a different plane. And that disconnect is felt by everyone.
My addiction fueled inopportune disappearances that put pressure on my colleagues. I began to avoid social occasions. That’s not conducive to team bonding, nor to supportive relationships. A reluctance to network crimps your efficacy in many jobs, and a reluctance to be honest and vulnerable can cripple personal development.
That was my experience with opiates. Other substances might take you to the other extreme, of over-bonding with peers, colleagues, and clients. Booze-fueled misadventures and obvious, frequent hangovers do little good for you or for anyone else.
Then there’s the inevitable dishonesty that comes with hiding what is an ever larger and dominant part of your life. Even when the dishonesty is inconsequential, it intensifies your own sense of dislocation. There is something truly miserable about inventing cinema trips and football matches with friends when your colleagues ask about your weekend so you don’t have to tell them the sad truth—that you actually spent it sitting on the sofa looking at your shoes.
The toll
A substance may be functional at first in the sense that it helps you cope. But the addiction is papering over the problem, which is growing and growing all the while.
An addict may be “functioning,” but at what cost? What cost to their physical and mental well-being, to their social and professional life, to the well-being of their family?
Being a functioning human being means so much more than just maintaining a daily schedule.
You may be an adequate provider for your family, but what are you offering them emotionally? Are you there, but not really there? How is your sex life?
As a counselor, I have worked with clients who are functional in the sense they have maintained a job, but their family members, who bear the brunt of them clinging on at work, paint a different picture.
Sometimes the emotional burden of being close to a “functioning addict” leaves the spouse or parents struggling to work.
And what toll is it taking on your body? Prolonged abuse of most substances will catch up with you. Something will eventually be knackered, whether that’s your liver, lungs, or lymph nodes. (“We’re holding it down…” “Yeah right…” groans your pâtéd liver.)
Still functioning addicts are often tolerated by employers because they get the job done. Warning signs are overlooked or rationalized. But the sooner an employer can set the process of change in motion, the better. The more entrenched the addiction, the harder it is to shake it.
Exceptions
Addiction is a complex matter, and treatment can be as varied as the many people who struggle with it. It would be an oversimplification to say that if addiction is dysfunctional, abstinence is by definition functional.
Sometimes harm reduction maintenance programs use substances such as buprenorphine and methadone to offer stability on a temporary or even permanent basis. There’s even been the occasional heroin-assisted treatment program such as those in Switzerland, Canada, Germany, the UK, and the Netherlands, which have shown positive results.
When such programs are adhered to, functionality often goes up. People might be able to maintain a job for the first time in a long time. They might shift from crime to work.
Whether maintenance is a help or a hindrance in the long-term is ultimately a personal matter. These programs certainly save lives and often improve them. It might even get you to a place where you can function without it.
But while it may be an improvement from where you’ve been, is it a restriction on where you have the potential to get to? Opioids such as methadone cause cognitive impairment. Frequent, even multiple daily visits to doctors and pharmacies can be an impediment.
And when you get sober, the problems you tried to escape will likely still be there. They don’t magically disappear. You need to find other things to step in and fulfill the function once served by the addiction. You need to heal the void you tried to fill with the substance. This can be a challenging but rewarding process in itself. It adds richness to your life, even though it is far from easy.
Whether that’s relieving stress through lunchtime walks, attending recovery meetings after or even during the working day, tapping into a support network, taking an afternoon meditation break, or healing through therapy.
Sometimes roles need to be reconfigured. For example, if someone was drinking and using coke to be the bubbly client party host they don’t really feel like, they may need to shed that role altogether, or arrange the option of an early departure from such events.
Being a functioning human being means different things to different people. But we should reconsider how we use the term. Let’s not let the “functioning addict” trope keep you—or anyone struggling with addiction—from seeking help, or from finding out how fulfilling and rewarding life can be beyond it.