Many people envision alcoholism, also known as alcohol use disorder (AUD), as something that is easily recognizable. In reality, though, this is far more complicated. Some people consume enormous amounts of alcohol regularly, while working hard in their careers, raising families, and maintaining social obligations, so that everyone around them sees nothing wrong with their behavior. However, appearing to function on the outside doesn’t mean that excessive alcohol consumption isn’t a problem that exists for the individual. If someone you care about fits this example, here is some information you should know.
What is a High-Functioning Alcoholic?
A high-functioning alcoholic refers to an individual meeting the diagnostic criteria for alcohol use disorder (AUD), but is able to manage their professional life, relationships, and personal responsibilities in a manner that appears “normal” to those around them.[1]
From the outside looking in, it may appear as though everything is fine for the individual. On the inside, however, the individual’s consumption of alcohol is negatively impacting their health, their thought processes, and their emotional well-being in ways that are not immediately apparent, sometimes even for the individual themselves.
Healthcare providers do not use the term “functional alcoholic” as a formal diagnosis. Instead, the clinical term used to refer to a pattern of alcohol consumption that creates significant distress or harm is referred to as an alcohol use disorder. An alcohol use disorder can range from mild to severe. Therefore, a person can be considered a functional alcoholic and still be somewhere along that range.
Functional Alcoholic versus Alcohol Use Disorder
The phrase “functioning alcoholic” is a term that people use to refer to someone whose drinking problem has not yet been revealed through typical indicators of an impending crisis, such as legal difficulties or job loss. An alcohol use disorder represents the actual underlying process occurring beneath the surface.
One of the biggest misconceptions regarding AUD is that an individual must reach “rock bottom” prior to their drinking becoming problematic. That is not accurate. Being able to function does not equate with the absence of harm caused by alcohol. More often than not, it simply signifies that the harm has not yet reached a point that alarms those around the individual.
Why People Often Miss Warning Signs
It is easy to dismiss concerns regarding someone’s drinking habits when they are gainfully employed, financially secure, and socially competent. Socially acceptable patterns of drinking are common in many professional circles. As such, rationalizations regarding excessive drinking occur more readily. Additionally, someone who performs well in their career may honestly believe they do not have a problem with their relationship with alcohol.
Warning Signs of High-Functioning Alcoholism
Increased Alcohol Tolerance
An increase in tolerance to alcohol occurs when the body adjusts to consuming large quantities of alcohol on a consistent basis. Consequently, larger quantities of alcohol must be consumed to achieve the desired effect. A person who consumes substantial amounts of alcohol without appearing intoxicated cannot shield themselves from its deleterious effects. Increased tolerance to alcohol is one of the hallmarks of alcohol dependence.[2]
Consumption Becomes Part of the Daily Routine
Using alcohol to relax, sleep, or deal with stress indicates that alcohol has transitioned from an enjoyable recreational pastime to a coping tool. Feeling anxious or irritable on days when access to alcohol is limited constitutes a warning sign, regardless of whether the individual exhibits intoxication.
Hiding and/or Minimizing Consumption Habits
Hiding, lying about, or minimizing the degree of alcohol consumption are behaviors indicative of some degree of recognition that the individual’s drinking habits constitute a problem. Individuals who comfortably engage in drinking typically do not conceal it.
Rationalizing Alcohol Use
Ongoing justification for engaging in excessive drinking (i.e., due to work-related stress, social requirements, or claims of “everybody drinks”) suggests that the individual views their consumption of alcohol as necessary. Rather than viewing their drinking habits as enjoyable social experiences, they view their drinking as a means to avoid feelings associated with discomfort related to their drinking habits.
Emotional Instability and Irritability
Irritability, mood swings, and emotional instability (particularly when no longer having access to alcohol) are commonly experienced by individuals with alcohol dependence. These fluctuations in emotion often cause problems in interpersonal relationships and contribute to increasing emotional instability, including worsening anxiety and/or depression over time.
Memory Loss and Blackouts
Alcohol-induced blackouts impair an individual’s memory so that events that occurred while they were intoxicated are fuzzy or forgotten.[3] Blackouts occur whether or not an individual loses consciousness. For example, an individual could engage in conversations or make decisions while intoxicated with no recollection thereof upon regaining sobriety.
Withdrawal Symptoms Between Drinks
Symptoms of physical withdrawal (including tremors, sweating, anxiety, and difficulty sleeping) when not consuming alcohol indicate an advanced stage of alcohol dependence. Alcohol withdrawal can be dangerous or deadly, and an individual should receive medical management.[4]
What Causes Someone to Become a High-Functioning Alcoholic?
Common contributors to excessive drinking include chronic workplace pressures, stressors, trauma, grief-related issues, and family history of AUD. Anxiety, depression, PTSD (post-traumatic stress disorder), bipolar disorder, and other substance abuse disorders frequently co-exist with an alcohol use disorder.[5]
Once someone begins drinking excessive amounts of alcohol as a coping mechanism for dealing with painful emotions, a pattern of dependency takes hold. Individuals may initially begin heavy drinking as a method to cope with symptoms associated with a mental health issue before receiving a proper diagnosis and treatment.
Hidden Risks Associated With High-Functioning Alcoholism
Negative Consequences Regarding Health
Regardless of whether or not an individual functions well, continued heavy drinking will ultimately result in health problems. Chronic health risks resulting from excessive drinking include liver damage, cirrhosis, cardiovascular disease, high blood pressure, and elevated risk for various cancers. [6,7] Most of these complications occur over prolonged durations without exhibiting obvious symptoms.
Impact on Mental Health and Relationships
Chronic excessive drinking exacerbates mental health problems and contributes to isolation. Alcohol use disorders have detrimental impacts on relationships, regardless of whether consumption is observable as excessive. Continued emotional detachment from family members, conflicts with family members due to alcohol’s priority in their lives, and isolation contribute to negative relational effects.
Progression of the Condition Over Time
Alcohol use disorders progress over time. Eventually, reduced productivity and cognitive impairment secondary to heavy drinking will manifest before crises occur. The gap between appearance of normalcy and normal function will generally grow larger over time.
How Do I Know if Someone I Care About May Have a Problem?
Loved ones often identify issues earlier than others. Changes in personality, defensive responses when discussing alcohol, repeated failures to follow through with plans to reduce drinking, increasingly spending time alone, and drinking alone are all warning signs of AUD.[8]
If you find yourself questioning whether someone you care about has a problem with their drinking, you can trust that instinct!
How to Help a High-Functioning Alcoholic
Start With Compassion, Not Confrontation
Effective discussions regarding possible problems with excessive drinking will originate from caring and concern rather than accusation or blame. Schedule a non-confrontational time and discuss your concerns based on what you’ve observed rather than attacking the individual. Describe worrisome behaviors or events, rather than commencing on amounts consumed.
Express Your Concern Using Specific Examples
Specific instances of behavior rather than general statements about an individual’s character are more likely to be understood and less likely to elicit defensiveness. Compare what you’ve seen specifically (“you appeared different after our company dinner last week”), as opposed to comparisons that might be interpreted as accusatory (“you drink too much”).
Avoid Enabling Behaviors
Engaging in behaviors that protect others from consequences of another’s excessive drinking or diminishing your own concerns may encourage continuation of the problem. Avoiding enabling behaviors does not imply being insensitive; it means avoiding taking responsibility for covering up negative consequences stemming from someone else’s excessive drinking.
What Not to Say
Saying phrases like “you really aren’t that big of a problem,” “at least you aren’t as bad as [others]” or “just drink less” trivializes the realities associated with an alcohol use disorder and may impede someone from seeking help. An alcohol use disorder is not about willpower.
Encourage Professional Support
Primary care physicians, therapists, addiction specialists, and support groups (such as Alcoholics Anonymous) can assist with recovery. Generally speaking, early involvement results in better outcomes for long-term recovery.
When Should Someone Seek Treatment?
Some warning signs that it’s time for professional assistance include an inability to curtail their drinking habit despite desiring to do so, cravings, physical symptoms associated with withdrawal, and continued excessive drinking despite the adverse effects on their overall health and/or relationships.
Recommended treatment options include:[9]
- Medical detoxification (healthcare professionals provide safe management of withdrawal symptoms using medication and other treatments)
- Residential programs
- Outpatient programs
- Behavioral therapy/counseling
- Medications used with counseling and supportive services designed to treat all aspects of an addiction
The best available evidence supports using proven methods in varying degrees depending on need. Ongoing support and aftercare are essential components of successful long-term recovery.
Recovery does not necessitate losing everything first. If you suspect you or someone you care about may be experiencing symptoms associated with a high-functioning alcoholic, contacting your doctor or a certified addiction counselor like those at All in Solutions is the initial step towards receiving quality assistance.