High-Functioning Alcoholics: Signs, Risks & Treatment Options

Persons with mild-to-severe alcohol use disorder (AUD) who are able to maintain success in their professional and personal lives are referred to as functioning alcoholics. Unlike others affected by AUD, they are able to carry out their daily activities, avoid becoming involved in major legal breaches, and conceal their disorder, at least for a period of time.8 

Since functional alcoholics are capable of keeping their alcoholism from impacting their relationships and work, they are more prone to blaming their issues on other things, developing graver forms of alcohol dependance, and refusing to confront their alcoholism for a much longer time.9

Functional alcoholics commonly do not display significant personality changes that are usually related to drinking. They typically seem to be completely or mostly sober despite excessive alcohol consumption. Therefore, they often remain in denial about their alcoholism and keep it concealed much longer than persons who display more obvious and immediate symptoms of alcohol use disorder.10

The stereotypical image of an alcoholic is often based on media representations and some rather extreme cases of alcohol abuse that we may witness. However, this does not necessarily reflect what alcoholism actually looks like in everyday lives of many individuals. One of the patterns of alcohol abuse that has recently gained more attention is often referred to as functional alcoholism.

Although it can severely affect a person’s health, relationships, and career, this problem often remains under the radar due to the fact that so-called functional alcoholics may not fit the stereotype and are not very common among treatment-seekers.

Addiction treatment centers don’t offer specific functional alcoholic treatment. This is because functional alcoholism is essentially the same as alcoholism and is treated the same way.

What Is a Functional Alcoholic?

An extensive study carried out by the National Institute on Alcohol Abuse and Alcoholism that analyzed a national sample of people with alcohol dependence found that as many as 20% of alcoholics in the U.S. are highly-functional, well-educated individuals with good income. They are typically middle-aged with stable jobs and families. About one-third of people from this category had a family history of alcoholism, about one quarter has suffered from depression at some point in their life, and around half of them are smokers.

On the other hand, those with chronic severe alcoholism, who are the most prevalent group in alcoholic treatment, actually make up only 9% of alcoholics in the U.S. In other words, the number of those who struggle with alcohol yet are able to function on what appears to be normal levels, which would often not be seen as alcoholics in their community, is a lot higher than the number of “obvious”, i.e. more severe cases.¹

According to Sarah Allen Benton, therapist and author of the book Understanding the High-Functioning Alcoholic, highly-functioning alcoholics often live in denial due to the fact that they are able to work, excel academically, and provide for their family. They often believe they deserve a drink because of their hard work or stress, and that it will not affect anyone from their environment.²

What Are the Signs of a High-Functioning Alcoholic?

The symptoms and the causes of alcoholism can significantly vary. A lot of functional alcoholics are able to downplay or cover up different stages of AUD for a very long time. Their family members, coworkers, and classmates are commonly unaware of the extent of their alcohol consumption. In case you or your loved one manifests some of the following signs, you may be facing functional alcoholism:8, 9, 10

• Concealing or downplaying their alcohol consumption. 
• Consuming alcohol before and/or after events and/or secretly bringing alcohol to events that do not offer it. 
• Operating vehicles while under the influence of alcohol.
• Concealing their drinking from family members, colleagues, and classmates.
• Drinking alone.
• Not seeming intoxicated despite heavy consumption. 
• Denying, challenging, or avoiding any criticism regarding their drinking.
• Dealing with stress by drinking.
• Downplaying their alcoholism by comparing themselves to persons who have experienced more serious issues with alcohol.
• Having a strong urge to finish drinks, even if those drinks are not theirs. 
• Experiencing blackouts caused by alcohol.
• Refusing to reduce alcohol consumption even when it has led to or intensified one or more of their mental or physical issues. 
• Obsessively talking or thinking about the next time they will have a drink. 
• Rewarding themselves with alcohol for good performance at school or work.

What Are the Dangers of High-Functioning Alcoholism?

Both non-functioning and functioning alcoholics who suffer from alcohol use disorder are prone to different physical or mental health issues that are worsened or caused by their AUD.11

Short-term health issues potentially caused by alcoholism include:11

• Violent behavior (familial violence, assault, suicide, homicide, etc.).
• Acute alcohol poisoning (alcohol intoxication).
• Fetal alcohol spectrum disorders (FASDs), stillbirth, miscarriage among pregnant individuals.
• Injury resulting from excessive intoxication (falls, slips, burns, cuts, driving accidents, drownings, etc.). 
• Risky sexual behavior (having intercourse with multiple partners, not using protection, etc.).

Long-term health issues potentially caused by alcoholism include:11

• Heart disease, stroke, high blood pressure, digestive tract issues, liver disease.
• Cancer (breast, mouth, colon, esophagus, rectal, voice box). 
• Mental health problems (anxiety, depression, etc.).
• Social issues (complications at work, unemployment, family problems, etc.). 
• Learning and memory problems (bad performance at school, dementia, etc.). 
• Alcohol use disorder (AUD) or alcohol addiction. 
• Increased risk of infections (weakened immune response).

Confronting a High-Functioning Alcoholic: How to Do It

Once you inform yourself about AUD, the following step should be talking to your dear one regarding their addiction. Bear in mind that functioning alcoholics tend to find it hard to accept that they are facing a problem. Consequently, a single conversation will probably not suffice to persuade them that they should go into treatment. Therefore, it is recommended to the family members of functional alcoholics that they exercise patience and continually support their loved one by offering assistance and listening attentively.12

The following approach is recommended by the Substance Abuse and Mental Health Services Administration (SAMHSA) to confront your dear one about their alcohol use:12

• The discussion should be carried out at home, while taking a walk, or in another similarly private and quiet environment that is free of distractions and stress.
• Be sincere when expressing your concerns, but convey them in a tender way. Ask them how they feel and be a patient listener. 
• Refrain from reacting in a harsh or judgemental way. Hear what your loved one has to say and provide emotional support. 
• Explain to them that addiction is a disease, and that research-backed treatment is available. Talk about the various rehabilitation programs that exist.

Why Functioning Alcoholics Refuse Treatment

Functioning alcoholics often refuse to admit the severity of their alcohol use disorder. Some of them deny having a drinking habit at all, even though their family members, coworkers, and classmates continually observe this habit. In some instances, they may deny having a problem even after being faced with obvious consequences such as a health issue caused by AUD or a DUI charge.8, 9

Career is another common obstacle to aiding these individuals. They are typically dedicated to their job and pride themselves on being able to perform well at it. Consequently, the reason for them to refuse going into treatment for their alcohol use disorder is often their belief that it may cause them to be dismissed.8, 9

A lot of high-functioning alcoholics cope with feelings of embarrassment and shame regarding their alcohol use disorder. They may feel their drinking is a personal failure and believe that admitting to having a problem and becoming diagnosed with AUD would impede their success in both professional and personal life.8, 9

What Qualifies You as an Alcoholic?

It is important to note that functional alcoholism is not a separate disease — it still counts as alcohol use disorder (AUD). As opposed to moderate alcohol consumption, 2015-2020 Dietary Guidelines for Americans define high-risk drinking as:³

• Consumption of 4 or more drinks on any day or 8 or more drinks per week for women.
• Consumption of 5 or more drinks on any day or 15 or more drinks per week for men.

Binge drinking is defined as the consumption of 4 or more drinks for women and 5 or more drinks for men within a period of about 2 hours.

Doctors diagnose AUD when a patient’s drinking causes distress or harm. However, sometimes symptoms are mild but may still signal the start of a drinking problem. A tool developed for this purpose is the questionnaire available at the website of the National Institute of Health, which lists 11 indicators that can help individuals and their family members identify risks and possible AUD.⁴

What Do You Need to Know About Someone Who Is Referred to as a Functional Alcoholic?

Although sometimes symptoms of AUD are not obvious in high-functioning alcoholics, these are some symptoms that a person may be abusing alcohol:⁵

• Drinking alcohol as a reward
• Telling others they drink often to relieve stress
• Drinking alcohol rather than they eat and saying they have no interest in eating
• Always having an excuse as to why they drink
• Hiding alcohol bottles or being dishonest about how much they have drunk

Treatment Programs for Functional Alcoholics

Extensive research on substance use disorders has demonstrated that every SUD is unique and that there is no universal treatment for AUD. Every treatment is tailored to the specific needs of an individual patient, and the cost of it may vary accordingly. Science-based methods that have been shown to yield the highest prospect of success include:13

• Alcoholics Anonymous (AA). The AA is a community of people who help each other in achieving sobriety. They follow a free 12-step process that allows their members to support each other on their journey to a complete recovery.14

• Inpatient treatment involves high-intensity therapy and constant monitoring. Accordingly, patients are required to live at a treatment center during the rehab.13

• Outpatient treatment is convenient for persons who are unable or unwilling to commit to twenty-four-hour rehab, patients without a history of relapse, and milder AUD cases.13

• Group therapy. A group of people who share similarities in their alcohol addiction disorders meet at a session that is led by a therapist in order to work out their problems and share experiences with each other in a controlled environment.13

• Dual diagnosis. Research has shown that 50% of individuals suffering from SUD also suffer from one or more co-occurring mental health issues. Creating a customized treatment that addresses these disorders concurrently is essential for helping an individual achieve long-term sobriety.13, 15

• Individual therapy. The patient regularly meets with a mental health therapist to specify and address the underlying issues that have led to the development of alcohol use disorder. The therapist shows them how to apply coping mechanisms that can help them reduce the risk of relapse.13
• Therapeutic community. The patient is required to stay in the treatment center between 6 and 12 months. The treatment focuses on the individual’s resocialization through the help of the entire community, including staff and other residents. It is highly structured and at times confrontational. The activities focus on helping the individual examine destructive patterns and self-concepts and adopt more constructive ways of interacting with others.13
• Detox. Detoxification is a short process that typically lasts between 3 and 7 days or 10 and 14 days for severe or long-term alcohol users. It focuses on minimizing potential withdrawal symptoms. However, it is not an isolated approach, but the initial step towards the complete recovery.17

Treatment can be accompanied by medication distribution in order to provide a sense of calmness and reduce the severity of withdrawal symptoms. Medications that are typically prescribed include anticonvulsants, barbiturates, benzodiazepines, and alpha-2 agonists.18