Functional Alcoholism: All You Need to Know
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 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
Frequently Asked Questions
Excessive alcohol puts people at an immediate increased risk of:6
- Accidents such as car crashes, falls, drownings, and burns.
- Violence such as sexual violence or homicide.
- Risky sexual behavior that may result in sexually transmitted diseases.
- Miscarriage, stillbirth, or fetal disorders in pregnant women.
Not immediately, but rather over a period of time, excessive alcohol use can lead to the following health issues:6
- Chronic diseases: hypertension, heart disease, stroke, liver disease, and digestive problems
- Certain types of cancer (breast, mouth, throat, esophagus, liver, and colon)
- The weakening of the immune system
- Problems in learning and memory
- Mental health problems, the most common ones being depression and anxiety
- Problems in family relationships or at work
- AUD or alcohol dependence
As with any kind of addiction, there is no one-size-fits-all solution. According to the recommendations of the National Institute on Alcohol Abuse and Alcoholism, talking to a primary care physician is an important first step in establishing diagnosis and looking into treatment options.7
Essentially, treatment options for someone referred to as a functional alcoholic would be the same for an individual struggling with more severe symptoms. In addition to the officially approved medications for treating alcohol dependence, there are also several forms of behavioral treatment. These are:7
- Cognitive-behavioral therapy.
- Motivational enhancement therapy.
- Marital and family counseling.
- Brief counseling interventions.
All these forms of therapy aim to change the patterns of thinking and behavior that have led to alcohol abuse and help the person develop coping strategies in order to prevent relapse.
There are a number of treatment centers across the country which offer various forms of inpatient and outpatient treatments. In addition, there are also groups for continuous support such as Alcoholics Anonymous and their 12-step program.
- It is most often the closest ones that need to approach and talk to the person who is struggling with alcohol. If you have a loved one who needs help, make sure to communicate with them and help them seek appropriate treatment.
1. National Institutes of Health (2007). Researchers Identify Alcoholism Subtypes.
2. Benton, S. A. (2009). Understanding the high-functioning alcoholic: Professional views and personal insights. Westport, Conn: Praeger.
3. Health.gov. 2015-2020 Dietary Guidelines. Appendix 9. Alcohol.
4. National Institutes of Health. What are symptoms of an alcohol use disorder? – Rethinking Drinking.
5. Healthline. (2017).High-Functioning Alcoholic: Overview, Diagnosis, and Treatment.
6. Centers for Disease and Control Prevention. (2020). Alcohol Use and Your Health.
7. National Institute for Alcohol Abuse and Alcoholism (2014). Treatment for Alcohol Problems: Finding and Getting Help.