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There are many stereotypes about alcoholics. We've all seen how they're portrayed in TV shows and movies. You may think they're grumpy, irresponsible people who can barely keep their lives together. However, that's not always the case.
Alcohol use disorders (AUD) can manifest in many ways. Some people are able to live successful lives even though they have an alcohol addiction. They may have a good job, a robust social life, and even a happy family at home.
High-functioning alcoholics, also known as "functional" or "working" alcoholics, look and act just like their peers. On the outside, they'll appear healthy and successful. Most people won't realize that they have a problem. In some cases, only their loved ones or people living with them will notice their drinking patterns.
What is a High-Functioning Alcoholic?
High-functioning alcoholics meet the criteria of having an alcohol use disorder (AUD) but are still capable of maintaining their work and personal life.
These 11 symptoms can be used to determine whether someone has an AUD
- You consume more and more alcohol (larger amounts or over a longer period of time).
- It is difficult to cut down on your excessive drinking.
- You spend a lot of time getting, drinking, or recovering from alcohol.
- You feel strong urges or cravings to drink.
- Obligations and responsibilities like work, school, and relationships with friends and family members fall to the wayside.
- You keep drinking alcohol despite alcohol-induced social or interpersonal issues caused by alcohol.
- You stop or reduce important social, work, or recreational activities due to alcohol use.
- You continue to use alcohol in risky situations that could cause you physical harm.
- You continue to drink despite knowing it is causing you health problems or harming you psychologically or socially.
- You've developed a high alcohol tolerance that requires you to drink more and more to achieve the same effect.
- You've experienced alcohol withdrawal symptoms, including nausea, irritability, or tremors (delirium tremens).
The severity of their AUD depends on the number of symptoms they have:
- 2 to 3 is considered mild
- 4 to 5 is considered moderate
- 6 or more is considered severe
Functional alcoholics are often considered "successful" by their friends and society. They might be college-educated, have partners or be married, and have jobs with relatively good salaries. They tend to restrict their alcohol abuse to specific situations or times. This presents the illusion that they are in control of their alcohol use.
Many people are in denial about their high-functioning alcoholism. They may convince those around them that their drinking is not problematic. They minimize the problems they experienced caused by their alcohol consumption. Many even believe the problems would exist for them with or without alcohol. However, they still suffer from the effects of their substance abuse.
Functional alcoholics might have co-occurring mental health issues, such as depression or anxiety.
Signs of High-Functioning Alcoholism
A functional alcoholics disorder has yet to display most of the noticeable effects of alcoholism. They likely experience negative consequences caused by alcohol abuse, but they do little to affect their functioning in everyday life.
In many instances, a functional alcoholic will have a family member, often a spouse, cover for them when alcohol-related issues arise. For example, one’s spouse might call in sick when the functional alcoholic has a hangover.
Functional alcoholics might also isolate themselves from other people in order to spend time alone drinking.
High-functioning alcoholics tend to drink a moderate amount of alcohol consistently throughout the day without getting drunk. This ongoing stream of alcohol into their system usually keeps cravings at bay and prevents withdrawal symptoms. Some might binge drink, but it tends to be on the weekends or at night when it doesn’t affect their work.
A high-functioning alcoholic might also:
- Deny or diminish the amount of alcohol he or she is drinking
- Joke about having an alcohol problem
- Justify alcohol misuse by drinking "top-shelf" or "celebrating" unimportant events
- Drink a large amount of alcohol and not appear drunk
- Drink at lunch time, or have an excessive number of drinks at dinner
- Drink enough to cause a blackout
- Get arrested for drinking while under the influence of alcohol
- Miss school or work without a legitimate reason
- Get confrontational or upset about inquiries into his or her alcohol consumption
A functional alcoholic will usually appear healthy even though they consume a higher-than-healthy amount of alcohol. Some may drink for years without experiencing health problems, but eventually, their alcohol consumption will negatively affect their body.
Many high-functioning alcoholics only realize they had a long-term problem when they are older and their liver, heart, and brain health are damaged.
It may seem that high-functioning alcoholism is not as severe as other types of alcoholism because they can maintain a job, a family, a social life, and appear “normal.” But they have an addiction to alcohol. It has just progressed differently and they have learned to manage it better.
Characteristics of High-Functioning Alcoholics
Every person with an alcohol use disorder displays a unique combination of symptoms and side effects. There is no “typical alcoholic.” It could be very difficult to identify someone with alcohol use disorder without knowing them very well. This is especially true if a person is a functional alcoholic. In many cases, only close friends and family, and maybe only a person’s spouse recognizes the signs of a problem.
There are several things you might notice if you or a loved one is a high-functioning alcoholic. For instance, high-functioning alcoholics tend to use alcohol:
- To boost confidence
- To relax
- First thing in the morning
- Alone
- Everyday
- For binging
Three characteristics of high-functioning alcoholics include:
- Inability to limit alcohol intake to one drink
- Replacing meals with alcohol
- Hiding the amount of alcohol consumed
There’s a misconception that a high-functioning alcoholic will not experience the same consequences as other types of alcoholics. This is not true. They might perform better at work and hide their alcohol use disorder better than others, but eventually, there are negative consequences.
Health Problems Caused by Alcoholism
There are numerous health problems caused by unhealthy drinking behaviors and alcohol dependence.
Short-term effects include:
- Alcohol poisoning
- Injuries such as falls, motor vehicle accidents, and burns
- Violence such as fighting, sexual assault, or domestic violence
- Risky sexual behavior such as unprotected sex
- Miscarriage among pregnant women
However, many functioning alcoholics won't experience these short-term effects. In some cases this increases their level of denial. They may be convinced that their drinking is not an issue because they don't engage in binge drinking. However, these are not the only effects of drinking.
Long term health risks include:
High blood pressure
Drinking can raise your blood pressure to an unhealthy level. Having more than three drinks at one time can temporarily raise your blood pressure. Repeated heavy drinking can lead to long-term high blood pressure problems.
Heart Disease
Alcohol increases your risk of blood clots and increases your fat and cholesterol levels. Alcoholics may have trouble pumping blood to their heart and have a higher chance of heart disease. This can result in early death.
Liver damage
Alcohol is processed by your liver. Drinking too much can kill your liver cells. This can lead to cirrhosis, fatty liver diseases, and other liver problems that can seriously effect your overall health.
Cancer
Alcohol use has been linked to several types of cancer. These include mouth, throat, esophagus, liver, breast, and intestinal types of cancer, among others. Long-term drinking increases your risk of developing cancer.
Brain problems
Alcohol can change your brain's communication paths. This interferes with your ability to think, speak, remember, make decisions, and learn new things. Sustained drinking habits can also cause mental health disorders like depression, anxiety, or dementia.
Seizures
Long term drinking can increase your chance for epilepsy. Alcohol withdrawal is also a cause of seizures.
Weak immune system
Drinking impairs your liver, which is vital for your immune system. It also reduces your immune cell functions. This makes it easier for you to get sick and your body may have a hard time fighting off infections.
Digestive issues
Alcohol can cause heartburn and nausea by inflaming your stomach lining. Long-term drinking increases your risk of ulcers, and inflammation in your esophagus, stomach, and gut.
What Causes a Person to Become a High-Functioning Alcoholic?
An alcohol use disorder can develop quickly or progressively. The earlier a person begins drinking the more likely he or she is to develop an alcohol addiction.
Several environmental and genetic factors affect a person’s risk of developing alcohol use disorder, including:
- Genetics
- Family history of alcohol use disorder
- Home life
- School or work environment
- Stress and stress management ability
- Social relationships
- Exposure to peer alcohol consumption
- Cultural or religious views
Whether or not a person can function or not in response to his or her alcohol use disorder is unpredictable. Some people develop an addiction and have obvious problems shortly after, while others can abuse alcohol for decades without major problems.
Is Treatment Necessary for High-Functioning Alcoholics?
Alcohol use disorder is progressive. It might develop quickly or gradually, but without treatment, it will get worse. Therefore everyone with alcohol use disorder needs treatment. Without intervention, it is only a matter of time before a high-functioning alcoholic becomes non-functioning.
High-functioning alcoholics tend to believe they do not need treatment. In rare cases, this type of alcoholic might passively seek support, but because of their ability to function, they never receive a diagnosis.
This is unfortunate because treatment is the best way to get alcohol use disorder under control. Treatment also makes it possible to avoid long-term risks, something all alcoholics eventually develop.
In addition, functional alcoholics often require corroboration from family members or friends (particularly spouses) to engage in their behavior. Some sources refer to these types of relationships as codependent, although this is not a formal diagnosis but more of a descriptive term that is used to identify patterns of interaction that occur in individuals with dysfunctional relationships.
Even functioning alcoholics who never experience major problems are not living their best life. Some people compare it to living with untreated depression or anxiety. Life goes on, but it’s always less than it could be and the person never feels his or her best. With treatment, high-functioning alcoholics can better manage their disorder and reach their full potential.
Treatment Options for Alcohol Abuse & Addiction
- Inpatient Programs — Inpatient treatment is the most intensive and effective option for alcohol addiction treatment. These prograInpatient treatment is the most intensive and effective option for alcohol addiction treatment. These programs usually last 30, 60, or 90 days. However, they may be longer in some instances. Throughout an inpatient program, you will live on-site in a safe, substance-free environment. You will go through medically supervised detoxification first, then behavioral therapy and other services will be added to your regimen. Many of these treatment programs will assist you with an aftercare program afterward.
- Partial Hospitalization Programs (PHPs) — PHPs are the second most intensive alcohol addiction programs. They are sometimes referred to as intensive outpatient programs (IOPs). Partial hospitalization programs provide comparable services to inpatient programs. These may include detoxification, medical services, behavioral therapy, support groups, and other holistic or custom treatments. The main difference between PHPs and inpatient programs is that you return home and sleep at your house during a partial hospitalization program. Some PHPs provide food and transportation. However, this varies by program. PHPs are ideal for new patients, as well as patients who have completed an inpatient program and still require intensive treatment.
- Outpatient Programs — Outpatient programs are less intensive than inpatient programs and PHPs. They are best for people who are highly motivated to achieve sobriety and have responsibilities at work, home, or school. Outpatient treatment programs customize your treatment sessions around your schedule. Outpatient programs can help new patients achieve success. They may also be a part of aftercare programs once a patient completes an inpatient program or PHP.
- Medication-Assisted Therapy (MAT) — Certain patients qualify for medication-assisted therapy. Some medications can assist you throughout detoxification and withdrawal. Others can reduce cravings and normalize your bodily functions. Disulfiram (Antabuse), acamprosate (Campral), and naltrexone (Revia and Vivitrol) are the most common medications used to treat AUD. MAT can help prevent relapse and increase your chance of recovery if combined with other therapies.
- Support Groups — Support groups are peer-led organizations made of people dedicated to helping each other stay sober. They can be the first step towards sobriety or a component of an aftercare plan. Many of these programs follow the 12-step approach.
