A person is considered to be a functional alcoholic if they are afflicted with alcoholism but is nevertheless seen as someone who is managing a normal life. A functional alcoholic can be found everywhere: they could be surgeon, a professor, a lawyer, a civil servant, a merchant, or the person next door. One can be an alcoholic even when they seem to have a fulfilled life, stable job, good salary, house, friendships or social network.
Nothing associates him to the classic image of an alcoholic: that being the person who has a ruined life and drinks from morning until dawn. A functional alcoholic can also be a successful person, implying to everyone that he is responsible and productive since he works hard every day. For this very reason, people that live with him tend to ignore his drinking problem.
If someone starts to notice that this person drinks too much because something seems wrong (it is easier to use the surgeon’s trembling hands as an example or the person that regularly changes his behaviour because he has to drink), and decides to confront him with a question, the answer would not be too far from this: “I work, earn my money, have lots of friends, therefore I am not alcoholic”.
Evidently, this is not true and sooner or later, things will eventually crumble down. It is a question of time. And such time is not equal to everyone. After all this is about sick people, and the addiction speaks on their behalf, with all its characteristics. We are talking about natural manipulators who lie, omit, justify themselves and get angry when confronted with this reality.
Why are they considered an urgent theme for public mental health?
The theme is urgent because there are thousands of people in Portugal in this situation which do not acknowledge their own state. Neither those who live or work with them.In fact—and because everything seems normal in everyday life—people struggle to confront the alcoholic, even when the signs are starting to become evident. It is also normal that either the family or friends try to find justifications and excuses not to face the problem head on. We can point the finger to public information.
What usually happens, and this is the serious and preoccupying part, is that besides the harm they do to themselves, they can also be severely harming others. And this includes professional practice. It is not that hard to understand how serious a surgeon with trembling hands is, or a more aggressive policeman.
But whether it is managing teams or in more isolated jobs, this figure will end up misplaying his profession, without conscience of what is he doing, ran over by his sickness. For it is a situation commoner than what can be imagined. It is an urgent theme to be debated, if only to raise more awareness and, therefore, capacity to act when required, without fear and the usual minimisation of the problem.
Is it possible to live or work besides a functional alcoholic without being aware of it? How and why?
To a certain point it can be. However, if working as a team and people stay close, it will surely reach that moment when doubt will arise. In time, manifestations will happen more and more regularly and doubts become certainties. Nevertheless, it is quite rare to assume the situation and to look for help. All because there is shame, fear and an enormous capacity to stand everything which will translate into justifications, minimisations and comparisons with the classic alcoholic figure and therefore, denial. All of these are common defence mechanisms that always revolve around an alcoholic.
Despite everything, are there any signs of alarm? Is it possible to pinpoint 10 alarm signals?
There are indeed alarm signals. I will point out the following, but others may also arise. It is important to emphasise that to detect a functional alcoholic it is not mandatory that such person has all of these signs:
- The person drinks instead of eating. He may get drunk without any intention of doing so.
- May wake up without a hangover, since his tolerance is bigger than the occasional drinkers.
- When he is not drinking, will start showing up nervous signs, irritation, bad mood or even aggressiveness. He may also show signs such as sweats or trembling hands.
- He cannot drink only one or two drinks, will always be craving for more. If needed will finish his friends’ drinks, as means of a joke. But by his will, nothing will remain in the table.
- Periods of memory loss increase in frequency. It is usual not to remember what they have done the day before and not uncommon to regret some things when confronted with attitudes, conversations or promises. Fainting and blackouts may also occur.
- Whenever someone brings up the topic, trying to chat about the way that person is drinking or simply showing preoccupation will be faced with a denial response, justification or even aggression.
- He will always have a good explanation or excuse, e.g. because the day was good and he is celebrating. Or maybe because it went wrong and he is relaxing. A number of possible excuses.
- Hiding alcohol. Whether in the car, at home, in the office desk drawer or in the suitcase or coat.
- Behavioural patterns change significantly when drinking. They can immediately get in a good mood and open themselves to conversation, but quickly and as the consumption goes by, changes may become other. Either from euphoria to sadness or crying, or even from apparent normality to violence.
- This ever-present denial of his problem worries those who like him.
Will these alcoholics in disguise become more dangerous when it comes to public health? If so why?
Generally speaking any problem that is camouflaged or distorted becomes tendentiously more dangerous. These cases are in no way different. The question here is more of a serious one, especially since we are dealing with professionals, whose work more or less can severely harm others. Moreover by being camouflaged they can put entire families in jeopardy. And there are so many cases throughout Portugal. Generally, only when a serious accident takes place people realise they have to start asking for professional help. That is the bigger issue.
What to do in a case like this? What are the right attitudes towards someone in this situation? Which is the first indication suggested by an addiction counsellor?
The first indication is to take the first step without fear and make an appointment with a specialist. Let alone to expose the case at least and ask questions. From there on, things shall flow if the indications are followed. The existing problem is that, apart from treatment centres, which mostly use the Twelve Steps at Alcoholics Anonymous programme, there are not so many specialised professionals. It so happens that the national healthcare system has better doctors that are yet to fully understand the addiction disease. And even if given their best, it won’t be enough to help no matter how much they think they know about this disease. It is very important to choose who actually knows and follow counselling as best as possible. After all alcoholism is an addiction. It is a disease. It may not have a cure (it really doesn’t), but one can live in rehabilitation and have a happy whole (new) life.
Ana Pinto-Coelho is an addiction counsellor who has gained her degree from the University of Oxford. She is committed to advancing her profession in Portugal. Currently, she runs a private practice in Lisbon, Portugal and her commitment is to help individuals, and their families, who are struggling with addiction. She believes that counselling is both an effective and safe means to self-understanding, and ultimately recovery. For this reason, she has called her clinic Safe Place. You can follow her on Twitter @AnaPintoCoelho1