What is a Functioning Alcoholic? Signs of High-Functioning Alcoholism
However, someone who has experienced fewer external consequences as a result of their drinking can still benefit from professional help for their compulsive alcohol use.
This page is designed to help you identify whether you or someone you love may have or are at risk of developing an AUD and understand what professional help is available for those who appear to be ok but are in reality struggling through their daily as a result of their alcohol use.
What is a High-Functioning Alcoholic?
While some of the criteria used to diagnose an AUD include an inability to control drinking even after it has caused issues at their job or in their personal life, someone who is a “high-functioning alcoholic” may not demonstrate this diagnostic criteria. However, they may meet other criteria that leads to a diagnosis of AUD.2
Many people use the term “alcoholic” when referring to someone who is struggling with compulsive alcohol use. However, the proper way to address such a person is to say they have an alcohol use disorder. An alcohol use disorder is a treatable chronic medical disorder that causes long-term changes in the brain that make it difficult to control drinking without leading to clinically significant impairment or distress.2
Alcohol use disorder occurs along a continuum of severity with symptoms manifesting differently in different people.2 Some people may demonstrate AUD symptoms that develop more rapidly or prove to be more severe than others’ symptoms (and vice-versa). However, only a medical professional can diagnose someone with an AUD and determine the severity of their AUD.
One study on AUDs has estimated that about 20% of people who meet the diagnostic criteria for an alcohol use disorder appear to others to be highly functioning people who have successfully completed educational programs, maintain steady employment, and are well-paid.1 Other researchers and specialists estimate that as much as 50 to 75% of those with AUDs are able to function at a high level in many areas of their life.1
The current dietary guidelines for Americans from the federal departments of agriculture and health and human services recommend limiting alcoholic beverages. They also state that a person should consume alcohol in moderation if they are going to drink at all. Moderation is defined in the guidelines as being no more than 1 drink daily for women or 2 drinks daily for men. Someone who is a functioning alcoholic likely drinks more than this suggested amount or engages in periodic episodes of excessive drinking.3
Take Our “Am I an Alcoholic?” Self-Assessment
Take our free, 5-minute “Am I an Alcoholic?” self-assessment below if you think you or someone you love might be struggling with an alcohol use disorder (AUD). The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an AUD. The test is free, confidential, and no personal information is needed to receive the result.
Many people who abuse alcohol develop a tolerance to its effects.5,6 Alcohol tolerance develops as the body adapts to compensate for the disruption caused by alcohol, and a person must drink a larger amount of alcohol to produce the same effect.2,5,6 Tolerance is one of the criteria that can be used to diagnose an alcohol use disorder.2,7 However, tolerance (like other diagnostic criteria for alcohol use disorder) can decrease or disappear if you don’t drink for periods of time.7
Functional tolerance refers to a phenomenon where a person can ingest significant amounts of alcohol – either at once or slowly over time – and not appear to be intoxicated.2,6 A person who has developed a functional tolerance to alcohol may be under the influence of alcohol without it being noticeable, thus allowing them to participate in certain daily activities in a manner that appears normal to others.2,5,6
Are You or a Loved One a Functioning Alcoholic? Know the Signs
High-functioning alcoholism (or alcohol use disorders in general) can be hard to identify. There are certain behaviors that may indicate that someone has a problem with alcohol use. The diagnostic traits of an alcohol use disorder often overlap with behaviors displayed by a so-called “functioning alcoholic.”.1,2
Behaviors that may indicate that someone has high-functioning alcoholism, including:1,5,8,9
- Avoiding any critical input or feedback about your drinking patterns.
- Blacking out from alcohol consumption.
- Concealing how much alcohol is consumed, such as drinking before or after an event, sneaking alcohol when at an event where alcohol isn’t served, drinking by yourself, or hiding alcohol around the house.
- Continuing to drink even if it has caused or worsened physical or mental health problems.
- Denial of a drinking problem because of a lack of severe consequences, such as missing days or showing up late for school or work.
- Not fitting a predetermined image of an alcoholic, such as being able to maintain a well-groomed appearance.
- Drinking a large amount of alcohol and not appearing intoxicated.
- Drinking at lunchtime during work.
- Drinking in situations that can be dangerous, such as before driving.
- Drinking as a reward for doing a good job, or to cope with stressful situations.
- Drinking excessively when not abstaining but not indulging regularly, or you rationalize it because you can go for long periods without drinking at all.
- Experiencing cravings (i.e., a strong urge or need to drink) in specific situations.
- Feeling guilty or ashamed about being intoxicated or about the behaviors displayed while under the influence of alcohol.
- Feeling an overwhelming urge to finish drinks, even if they are someone else’s.
- Handling responsibilities well at home, school, and work in spite of drinking.
- Hiding alcohol consumption from coworkers, classmates, or family members.
- Justifying drinking as not problematic if the alcohol is top-shelf or is consumed at upscale events.
- Lying to yourself and/or others about how much you are drinking and how strong your drinks are.
- Making comparisons to people who have experienced worse problems with drinking, or severe consequences to show that your drinking isn’t that bad.
- Not seeing excessive drinking, which may cause psychological distress, as a significant problem in performing tasks of daily life.
- Obsessing over when you can attain your next drink.
- Trying to control how much you drink.
- Remaining well-known for doing an exceptional job at work or in school despite excessive alcohol use, which may or may not cause problems in other areas or psychologically.
If you or someone you love is exhibiting behaviors of high-functioning alcoholism, consider getting the advice of your doctor or another medical professional to discuss objectively whether or not your drinking habits are problematic.
Still wondering whether or not you or your loved one may have an alcohol use disorder? Take our AUD self-assessment to find out more.
Early Intervention: Why it Matters
Intervening early to diagnose and subsequently receive treatment for an alcohol use disorder can help someone prevent further progression in the severity of their disease. Early intervention may also prevent the development of further alcohol-related physical or mental health complications.2,9,10
Substance use treatment for a mild alcohol use disorder can often be provided in a minimally intensive outpatient environment vs. an inpatient or residential facility, and may even be offered through your primary care doctor.10
Treatment interventions for AUDs include behavioral therapy and medications. Screening for AUD and providing these early treatment interventions is becoming more frequent in the practice of primary care physicians. Primary care physicians are also facilitating earlier patient education about AUDs, and helping patients effectively manage cravings, cope with stressors in healthier ways, and prevent a return to unhealthy alcohol use.11 Should a primary care physician think a higher level of care is required, they may make referrals to more intensive methods of treatment.10
If you are living with a high-functioning alcoholic, you may be more likely than someone living outside of the household to notice their seemingly benign drinking habits. Consider having an open and honest discussion with your loved one about their alcohol use and encourage them to discuss it with a counselor or their primary care doctor.
Your loved one may deny having an issue with alcohol use, pointing out the ways they are functional in their daily lives and haven’t experienced the negative consequences typically associated with alcohol addiction.
In this situation, it may be good to remind your loved one that external consequences are not the only criteria used to diagnose an alcohol use disorder, and someone can still be affected negatively by problematic alcohol use even if they are able to function well in their daily lives.2
Your doctor or another medical or mental health professional can provide you with more information and guidance about alcoholism and suggest how to speak to your loved one.
How to Help a High-Functioning Alcoholic
It can be difficult to watch someone you care about struggle with alcohol use. If you are related to or in a relationship with a functional alcoholic, there are resources that can help them recover. These resources may be as close as their doctor’s office or it may include treatment facilities or peer support groups – all may be effective in someone’s aim to reduce or cease their unhealthy drinking behaviors.10
Alcohol addiction treatment is offered in a variety of settings, with the setting dependent on the unique needs and preferences of each individual.10 Inpatient or residential alcohol rehab is provided in a setting where the person stays in a facility for the entire duration of treatment and staff offers frequent monitoring and care.10,12 Outpatient care allows a person to continue to live at home not having to take time away from school or work, while receiving treatment that can range in intensity depending on the person’s needs.10,12
Peer support or self-help groups can also be helpful in reducing or stopping problematic drinking behavior. Alcoholics Anonymous is a 12-step fellowship that has meetings around the world to help people stop drinking using a spiritual-based program.13 SMART Recovery is a peer support group that encourages abstinence by applying evidence-based principles in meetings.14 Women for Sobriety encourages women to address emotional issues associated with alcohol use, along with contributing factors to alcoholism with the help of supportive relationships within the group.15
American Addiction Centers offers a range of treatment services in facilities across the country to help treat alcohol use disorders. With multiple facilities providing a full range of care from detox to outpatient treatment, American Addiction Centers can help your loved one overcome their unhealthy relationship with alcohol and co-occurring disorders such as depression. With our help, patients don’t only appear to function normally, but feel and experience life to its greatest potential as a sober and recovering individual.
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- Benton, S.A. (2009). Understanding the high-functioning alcoholic: Professional views and personal insights. Westport, CT: Praeger Publishers.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Centers for Disease Control and Prevention. (2020). Dietary guidelines for alcohol.
- National Institute on Alcohol Abuse and Alcoholism. (2020). Understanding alcohol use disorder.
- Fisher, G.L. (2011). Understanding why addicts are not all alike: Recognizing the types and how their differences affect intervention and treatment. Santa Barbara, CA: Praeger Publishers.
- National Institute on Alcohol Abuse and Alcoholism. (1995). Alcohol and tolerance.
- University of Virginia. (2018). Mechanisms of alcohol tolerance.
- Rinn, W., Desai, N., Rosenblatt, H., & Gastfriend, D.R. (2002). Addiction denial and cognitive dysfunction: A preliminary investigation. The Journal of Neuropsychiatry and Clinical Neurosciences, 14(1), 52-57.
- Becker, H.C. (2008). Alcohol dependence, withdrawal, and relapse. Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism, 31(4), 348-361.
- Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: US Department of Health and Human Services.
- Annals of Family Medicine. (2017). Now is the Time to Address Substance Use Disorders in Primary Care.
- National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction.
- Alcoholics Anonymous World Services. (2021). What is AA?
- SMART Recovery. (2021). About SMART Recovery.
- Women for Sobriety. (2021). Overview.