High-Functioning Drug Users: Signs, Risk Factors, Treatment & More

April 18, 2022

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Many people with substance use disorders are what we describe as “high functioning” - employed, domiciled, with successful social relationships, whose drug use may be occult and may not be obviously a problem. On the outside, high-functioning patients with addiction disorders may seem healthy but on the inside, this person may have deep struggles with drugs or alcohol. Left unaddressed, those struggles may worsen. Recognizing “high-functioning” drug misuse in yourself or others can help identify and address problems early.  

What Does the Term “High-Functioning” Mean in Reference to Someone with SUD?

A “high-functioning” person using drugs is not a formal medical term, but is more a common descriptor of someone who likely has a SUD but is doing well “hiding” the problem. 

Oftentimes these people are employed, have good social relationships and families, and who are not using substances in a public or obviously problematic way. Because of this, they may be able to explain some symptoms of their disorder away more easily than someone else. 

For example, a person with an alcohol issue may state that their use is not a problem because they are not missing work and the use is not (at least yet) affecting their job performance. Another example might be someone using marijuana every day might state that their use is not a problem because they have a happy marriage and are taking care of their children without problems.  

High functioning individuals with SUD are generally better at “hiding the problem” than someone who is not high functioning. However, hiding the problem doesn’t make it disappear. It just makes them a little harder to spot and a little harder to treat. Moreover, because the patient is “high functioning”, many of these diagnoses can be missed, making it harder for these patients to identify a problem and get the prompt treatment that would benefit them. 

How Do We Diagnose SUD in a “high Functioning” individual?

 Someone with a high-functioning form of addiction may be able to hide their risky behaviors better than others, but the underlying behaviors are the same, and so are the diagnostic criteria for SUD: [1]

  • Taking more of the substance than intended 
  • Inability to cut down or control use 
  • Spending a significant amount of time using, getting, or recovering from the substance 
  • Cravings for the substance 
  • Recurrent use that causes problems at work, school, or home 
  • Lack of participation in activities that don't involve the substance
  • Use in situations in which it's hazardous 
  • Continued use even when the person has endured a physical or psychological problem because of it
  • Tolerance for the substance
  • Withdrawal when someone tries to quit

What Makes High-Functioning Addiction Difficult to Identify?

Anyone with SUD might try to hide or explain away addiction symptoms. But people with high-functioning addiction are a little more able to do so because they are otherwise functioning successfully in other parts of their lives. About 20% of people with an alcohol use disorder are considered “high functioning”.[2] These people oftentimes are middle aged, well educated, employed, and otherwise seem to be functioning well.[3] Many “high functioning” jobs also lend themselves to substance use: Lawyers, advertising executives, stockbrokers, and medical professionals, are all considered high functioning professions, and yet the rates of substance use among these professions is often markedly higher than the general public 

Recovery Is Always Possible 

People with substance use disorders don't need to hit "rock bottom" before they can begin to recover. That's especially true of high-functioning drug users.

“High functioning” individuals with SUD may hang onto employment for years, even while that person's family grows weary of hiding the problems and helping to cover up issues.[5] Offering early intervention allows the family to intervene before SUD becomes unmanageable or even dangerous. 

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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  1. The Science of Drug Use and Addiction: The Basics. National Institute on Drug Abuse. https://archives.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics. July 2018. Accessed April 2022.
  2. Researchers Identify Alcoholism Subtypes. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/news-events/news-releases/researchers-identify-alcoholism-subtypes. June 2007. Accessed April 2022. 
  3. Substance Use Disorders by Occupation. National Safety Council. https://www.nsc.org/getmedia/9dc908e1-041a-41c5-a607-c4cef2390973/substance-use-disorders-by-occupation.pdf. Accessed April 2022.
  4. Amid a Labor Shortage, Companies Are Eliminating Drug Tests. It's a Trend That Could Create More Equitable Workplaces. TIME. https://time.com/6103798/workplace-drug-testing/. October 2021. Accessed April 2022.
  5. High Functioning Addicts: Intervening Before Trouble Hits. CMAJ. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883816/. January 2014. Accessed April 2022. 

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