I truly appreciated the article entitled “Treating the High-Functioning Alcoholic” in the March/April 2009 issue. Sarah Allen Benton covered an important and helpful topic, particularly for those of us who work extensively with clients referred because of DUI arrests.
That being said, I was particularly struck by the author's assertion that high-functioning alcoholics (HFAs) “don't always fit DSM-IV-TR diagnostic criteria for alcohol dependence or abuse,” followed by her suggestion that it “can be more effective to diagnose an HFA according to the symptoms described in the ‘Big Book’ of Alcoholics Anonymous.” Not only do I believe that I have never encountered an HFA who did not meet criteria for either abuse or dependence, but it seems to me that many HFAs meet diagnostic criteria for substance dependence but do not meet the three criteria the author cited from the Big Book.
I have encountered many HFAs who have continued their patterns of alcohol consumption despite significant negative consequences but do not appear to frequently crave or obsess over alcohol. Nonetheless, they clearly meet diagnostic criteria for substance dependence.
For this reason, I referred some of my clients to Benton's helpful and insightful article but cautioned them that the mere fact that they don't identify with the three criteria cited from the Big Book does not mean that they cannot be alcoholics.
Aaron Norton, MA, CRC, CAP
Registered mental health counselor intern
Integrity Counseling and Coaching, Inc.
Addiction Professional 2009 July-August;7(4):11