High-Functioning Alcoholic: Symptoms, Risks & Treatment
Last Updated: January 25, 2024
Alcohol use disorder is a broad term that describes a medical condition characterized by an inability to stop or control the use of alcohol. The lack of control continues even though it's causing negative consequences in various areas of a person's life. While we often associate an alcohol addiction with the most severe cases, the brain disorder can be diagnosed as mild, moderate or severe.
When we talk about someone with an alcohol use disorder, it's common for us to use the term "alcoholic." While not an official diagnostic term, it's a commonly used phrase in our society. According to the National Institutes of Health, there are many subtypes of alcoholism. One is functional alcoholism.
While someone with functional alcoholism may outwardly appear to have it all together, they are often struggling with an inability to keep their drinking under control. Alcohol addiction is a progressive disease, and over time, it can worsen without treatment. Early intervention and recognizing warning signs are the best ways to help someone who may have problematic alcohol use patterns.
What Is a High-Functioning Alcoholic?
An alcohol use disorder or AUD is defined as a problematic pattern of alcohol use by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This can lead to significant distress or impairment, and it's diagnosed as mild, moderate or severe depending on the number of symptoms a person experiences over the past 12 months. There are eleven total diagnostic criteria. As AUD progresses, it can cause brain changes, making it hard to stop drinking, and there is often a combination of environmental and genetic factors contributing to AUD vulnerability.
The term high-functioning alcoholic isn't a medical diagnosis. Instead, it can refer to a mild or moderate AUD. A functional alcoholic will still be able to meet some or all of their responsibilities at home or work despite risky drinking patterns and habits. A significant distinction between functioning alcoholism and more severe AUDs is that the former doesn’t have the same consequences in a person's life as the latter, but that doesn't mean the situation won’t become worse over time without intervention.
A medical or addiction professional can assess a person's symptoms and situation to make a proper diagnosis regardless of where they may fall on the AUD spectrum. Someone with mild AUD will have at least two symptoms from the list of eleven, occurring within 12 months. For a moderate AUD, there can be four to five symptoms, and someone with a severe AUD would have six or more symptoms.
What Is Functional Tolerance?
When someone regularly drinks alcohol, they may develop a tolerance. This is a criterion for diagnosing an AUD and may be one of the first symptoms someone experiences. Alcohol tolerance is a reference to a lowered effect of alcohol with ongoing exposure. The amount of alcohol consumed may not change, but there's less of an effect, or higher amounts may be needed to produce the wanted effects.
Functional tolerance can be a contributor to addiction because a person may chase the previous effects they enjoyed about drinking, like relaxation. More resistance to the effects of alcohol is associated with a faster progression to an alcohol use disorder and more severe AUDs.
Signs You or a Loved One Is a Functioning Alcoholic
While everyone's situation is different, some of the potential signs of a functioning alcoholic include:
- Using alcohol as a coping strategy for stress or problems at home, work or in relationships.
- A person who is a functioning alcoholic may outline limits for their drinking, like saying they'll only drink beer for the night. Without realizing it, the person may be trying to convince themselves and others they're in control of their drinking.
- Getting drunk unintentionally.
- Engaging in risky behaviors when drinking.
- Using any occasion as a reason to drink, whether happy or difficult.
- Having problems with memory.
- Hiding alcohol use or being in denial.
- Making jokes about alcohol use.
- Feeling shame over their use of alcohol.
- Separating alcohol use from other parts of their life.
There are many overlapping traits between functional alcoholism and more severe AUDs, which is why it's crucial to speak to a professional as soon as possible.
Why Early Intervention Is Important
When someone uses alcohol, it affects the brain in powerful ways. The feelings it creates can motivate the continued use of alcohol, causing an unhealthy cycle. The brain changes can progress and affect the function and structure of the brain, so the longer alcohol misuse goes on, the more severe the mental and physical effects can become. With early intervention, it's possible to break the cycle, and a person may be able to participate in a lower level of care, like an outpatient program, versus a more intensive residential program.
Primary care physicians can serve as an essential resource during the earliest stages of an alcohol use disorder. They can help potentially diagnose the condition and also provide direction in terms of treatment resources.
How to Help a High-Functioning Alcoholic
It's never easy to watch someone you love and care about struggle with alcohol misuse. If you have a functional alcoholic in your life, there are recovery resources available. These could be a primary doctor's office, a peer support group or a treatment facility. A combination of these could also be appropriate, depending on the situation. Everyone is unique, but treatment for any alcohol use disorder is available with settings dependent on the particular needs and preferences of every person.
If you believe that someone you love is a functional alcoholic, you can open up the lines of communication. It may be that they don't realize anyone else has noticed. When you speak to them, try to come from a place of compassion and empathy rather than judgment. You might also talk to other loved ones so that you can all come together and have an intervention to discuss their drinking habits and support them in their recovery if they opt to get help.
Treatment Options for High-Functioning Alcoholics
There are many treatment options available for someone who's dealing with any level of problematic drinking or alcohol use disorder, including functioning alcoholism. Residential treatment is usually the most intensive level of care and could be appropriate if someone needs to step away from their current environment and requires a lot of help to stop drinking. There are also outpatient programs, including intensive outpatient rehab, group therapy, individual therapy and support groups. All of these options integrate flexibility into the recovery process.
If you’d like to learn more about treatment for alcohol use disorders or how you can help yourself or someone you love, please reach out to a Recovery Advocate. The Recovery Village Kansas City is a leading evidence-based facility treating functioning alcoholism. We provide access to medical professionals and mental health resources.
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NIH National Institutes of Health. “Researchers Identify Alcoholism Subtypes.” June 28, 2007. Accessed January 9, 2024.
NIH National Institute on Alcohol Abuse and Alcoholism. “The Cycle of Alcohol Addiction.” 2021. Accessed January 9, 2024.
NIH National Institute on Alcohol Abuse and Alcoholism. “Alcohol Use Disorder: From Risk to Diagnosis to Recovery.” September 22, 2023. Accessed January 9, 2024.
Elvig, Sophie K. et al. “Tolerance to Alcohol: A Critical Yet Understudied Factor in Alcohol Addiction.” NIH National Library of Medicine, May 1, 2022. Accessed January 9, 2024.
Dubey, Michelle, LCSW, LISW, CCTS. “15 Signs of a High-Functioning Alcoholic.” Nevada Bar Association, January 2022. Accessed January 9, 2024.
Spithoff, Sheryl, MD CCFP, et al. “Primary care management of alcohol use disorder and at-risk drinking.” NIH National Library of Medicine, June 2015. Accessed January 9, 2024.