High-functioning alcoholics are often hiding in plain sight—and they’re often more dangerous than drop-dead drunks.

“He was never drunk when I interviewed him,” the late writer Truman Capote’s biographer told me.

“It was just a mistake. He didn’t hurt anyone,” a friend said of an acquaintance who got a DUI last year.

“She doesn’t drink much,” my husband said of me when a therapist asked about our drinking habits. “Just a little white wine.”

Alcohol is confusing. For one thing, it is selectively addictive. Some people can drink safely; others can’t. For another thing, although alcohol is a depressant, especially in large doses, new research shows that in moderate doses it can also act as a happy stimulant. The first few drinks make the world a better place. The next few have the opposite effect: The drinker “may not be able to grasp the thread of a conversation; his reflexes will be somewhat delayed, his speech slurred, and his gait unsteady,” writes Dr. James Milam in his classic study Under the Influence.

Because ethanol, the active ingredient in alcohol, is a very simple and very tiny molecule, it is the Speedy Gonzales of addictive substances, zooming right through the protective blood/brain barrier and delivering
an immediate punch. Once alcohol enters the bloodstream, it triggers a series 
of responses that can last 24 hours. Many heavy drinkers are always in some 
stage of inebriation or withdrawal, and this changes the way they engage with
the world. There may be hours—entire mornings!—when they appear to be “normal,” but there is no “normal” in the body or brain of a heavy drinker.

“That alcoholics are often in worse shape when their blood alcohol content is descending than when it is at its highest level is an extremely difficult point to grasp.”

Alcohol is metabolized at the approximate rate of one drink per hour. Someone who has two drinks before dinner, three beers with dinner and two nightcaps may pass out and wake up six hours late still drunk. If
 they sleep longer, they wake up with more alcohol out of their system but often in a painful state of withdrawal (along with dehydration and other nasty symptoms caused by the toxins that your body churns out as it processes the ethanol). Hangovers, which arguably have a greater effect on mood than alcohol itself, are the body’s scream for more. Soon enough, driven by a cellular level craving, the heavy drinker with a hangover will have that beer or that brandy in the coffee that quiets the disturbance, at least for a while.

Someone in withdrawal is even less likely to seem drunk than someone who has had a few drinks. But the effects can be deadly. “The strange truth that alcoholics are often in worse shape when their blood alcohol content is descending than when it is at its highest level is an extremely difficult point to grasp,” write Catherine Ketchum in her book Beyond the Influence. “The withdrawal syndrome represents a state of hyperexcitability, or extreme agitation in the nervous system. “ Ketcham uses the tragic example of Henri Paul, the driver of the car in which Princess Diana and Dodi Fayed were killed in 1997. Paul, who had a blood alcohol level three times the legal limit when his body was tested after the accident, had been waiting around the Ritz for two hours to drive during which he had little to drink. “Paul was drunk and he was in withdrawal,” Ketchum writes. “Both facts sealed his doom and the fate of his passengers.”

In Understanding the High-Functioning Alcoholic, Sarah Allen Benton makes the case that the image of the archetypal alcoholic—the stumbling Bowery bum—has obscured a much more common and infrequently treated type of alcoholic—the alcoholic who can function in the world and appear to be fine. Perhaps because high-functioning alcoholics do not tax government systems and cause social problems, they get far less attention than more dramatic drinkers. Although these high-functioning boozers sometimes do not 
meet the diagnostic criteria for alcoholism, they are desperately in need of help. Examples abound: from former First Lady Betty Ford to actor Robin Williams and musician Eric Clapton. Dr. Mark Willenbring, an addiction specialist, told Benton, “[High-functioning alcoholics] are successful students. They’re good parents, good workers. They watch their weight. They go to the gym. Then they go home and have four martinis and two bottle of wine. Are they alcoholics? You bet.”

I was one of those confusing invisible alcoholics. I didn’t stumble or slur. I didn’t break out in handcuffs. No one ever told me to stop drinking. There were
 no emergency rooms or rehabs. Most of the day, I considered myself sober. From the outside all was well: I had a loving husband, two terrific kids and an enviable career. From the inside I was hollowed out by despair. I got through the mornings on coffee and sugar, promising myself that I wouldn’t drink again. In this twilight state I lived my life—driving cars, arguing with the IRS, complaining about my marriage. By evening there only seemed one solution to the unbearable hammering of the hours—a glass of white wine, and then another. I felt entirely alone. Now, 20 years later, I realize that I had a great deal of company. Article Link…

Susan Cheever, a regular columnist for The Fix, is the author of many books, including the memoirs Home Before Dark and Note Found in a Bottle, and the biography My Name Is Bill: Bill Wilson—His Life and the Creation of Alcoholics Anonymous.