What Does it Mean to be a High-Functioning Alcoholic?

High-Functioning Alcoholics – Signs, Risks, and Getting Help

Most people who have alcohol use disorder (AUD) tend to display overt symptoms of addiction and find it difficult to stay successful in their professional lives, develop and maintain healthy relationships, and take care of their physical and mental health. High-functioning alcoholics differ from regular alcoholics due to their ability to (at least temporarily) conceal their AUD from coworkers and family members, and avoid serious infractions with the criminal justice system.1

High-functioning alcoholics frequently have high alcohol tolerance, which enables them to continue functioning in their day-to-day lives despite substantial alcohol consumption. In many cases, they may appear mostly sober even while drinking heavily. As a result, they are often able to stay in denial about their AUD and to delay seeking help for much longer than people whose alcohol dependence is more immediately obvious.2

What Is a High-Functioning Alcoholic?

The term “high-functioning alcoholic” denotes an individual who is seemingly capable of staying successful in their personal and professional life, and even appears to be physically healthy, despite suffering from an AUD. The majority of these individuals believe that they have their drinking firmly under control. Because of this, they are more likely to refuse to seek help, shift blame for their issues on other things, and develop more serious symptoms of AUD.3

Most functioning alcoholics tend to lie about how much they drink, and are often unwilling to acknowledge the negative effects their AUD has had on their health and relationships. Some of them may stay in denial about their AUD even when faced with clear proof that they have a problem, such as a DUI (Driving Under the Influence) charge.3

What Are the Characteristics of a High-functioning Alcoholic?

Research done by the National Institutes of Health indicates that 19.5% of people who suffer from alcohol use disorder in the US can be categorized as high-functioning. Most high-functioning alcoholics are middle-aged and well-educated, and about 50% of them have a familial history of AUD.4

50% of them have also been diagnosed with clinical depression, while 20% suffer from bipolar disorder. In addition to alcoholism, the majority of these individuals also abuse marijuana, cocaine, and other substances. It is estimated that only 25% of high-functioning alcoholics have ever gone into rehab for their AUD.4

What Are the Signs and Symptoms of a High-Functioning Alcoholic?

Due to their tendency to downplay and/or conceal their alcohol consumption, functioning alcoholics tend to be significantly more difficult to identify than regular alcoholics. Their loved ones, classmates, and colleagues frequently believe they drink much less than they actually do. The following behaviors are strong indicators that an individual may be a functioning alcoholic:1,2,3

• Hiding their drinking and/or claiming that they drink less than they actually do.
• Driving while under the influence of alcohol.
• Using alcohol to relieve stress or otherwise cope with difficult situations.
• Appearing more-or-less sober despite consuming substantial amounts of alcohol.
• Hiding alcohol around their workplace or home.
• Becoming known for their ability to do well professionally despite copious alcohol consumption.
• Justifying their drinking by comparing themselves to individuals who suffer from more overt symptoms of AUD.
• Consuming alcohol during breakfast or lunchtime at work or school.
• Refusing to limit their drinking even when their alcohol consumption is negatively impacting their physical and/or mental health.
• Drinking prior to and/or after events and/or secretly bringing alcohol into events where alcohol is not served. 
• Avoiding or pushing back against any criticism or feedback that pertains to their alcohol consumption.
• Performing hazardous tasks or operating dangerous machinery while intoxicated.
• Drinking alone.
• Rewarding themselves for good performance at school or work by drinking.
• Frequently talking or thinking about alcohol, and obsessing about when they are going to have their next drink.
• Having a powerful urge to finish drinks (even drinks that belong to other people).

What Are the Risks Factors of High-Functioning Alcoholics?

Both regular and high-functioning alcoholics are likely to develop a range of mental and physical health issues that are directly caused by their AUD. These include short-term and long-term risks, both of which can result in severe health problems, many of which can be life-threatening.5

Alcoholism carries the following short-term risks:5

• Alcohol poisoning (acute alcohol intoxication).
• Violent and/or suicidal behavior (assault, homicide, familial violence, self-harm, etc.).
• Irresponsible and/or dangerous sexual behavior (unprotected sex, having sex with multiple partners, etc.).
• Stillbirth, miscarriage, FASDs (fetal alcohol spectrum disorders) among pregnant individuals.
• Bodily injury caused by loss of control while intoxicated (falls, slips, burns, drownings, cuts, driving accidents, etc.).

Alcoholism also carries the following long-term risks:5

• Alcohol use disorder (AUD) or alcohol addiction.
• Cancer (rectal, colon, breast, voice box, esophagus, mouth).
• Liver disease, stroke, high blood pressure, heart disease, and digestive tract problems.
• Mental health problems (anxiety, depression, etc.).
• Greater risk of infections and other problems that stem from a weakened immune system.
• Problems with memory and learning (dementia, poor performance in school, etc.).
• Social problems (unemployment, complications at school or work, family issues, etc.).

How to Help a High-Functioning Alcoholic?

If you think a loved one may be hiding an alcohol addiction, it is strongly recommended that you take the time to learn about AUD and other substance use disorders (SUDs) before talking to them about their alcoholism. It is important to understand that AUD is a disease, and that it may be extremely difficult for your loved one to overcome it without your support. Furthermore, AUD is frequently accompanied by one or more co-occurring mental health disorders that need to be properly diagnosed and treated together with the AUD in order to maximize the chance of long-term recovery.6,7

Your first course of action should be to reach out to a hotline that specializes in alcohol addiction. This will provide you with an opportunity to speak to a knowledgeable and compassionate admissions navigator in complete privacy. In addition to being able to answer your questions about AUD and help you find facilities in your area that offer evidence-based treatment, the navigator will also be able to explain the available payment options, provide information on how healthcare insurance works in terms of addiction treatment, verify your insurance coverage for alcohol addiction rehab, help you find free treatment in case you cannot pay out of pocket, and advise you on how to help your loved one overcome their AUD. Depending on your loved one’s unique situation and needs, the navigator may also be able to arrange for same-day admittance into an appropriate alcohol rehab program.

How and When to Confront a High-Functioning Alcoholic?

Before speaking to your loved one about their drinking, it is essential to remember that both functioning and non-functioning alcoholics are often in deep denial about their AUD. While it is possible that a single conversation could be enough to convince them to get help, it is more likely that you will need to speak to your loved one on multiple occasions and gradually help them come to terms with their situation. This is why it is important to be patient and keep reaching out with offers to help.8

According to SAMHSA (Substance Abuse and Mental Health Services Administration), the following approach has the greatest likelihood of success when speaking to a loved one about their addiction:8

• You should discuss the matter with them in a quiet, private setting, such as during a walk or at home.
• While you should be upfront about your concerns, you should also phrase them in a calm and gentle way. Refrain from acting in a judgmental or confrontational manner. 
• Ask your loved one how they feel and be ready to listen. Provide them with emotional support and try to empathize with their point of view.
• Explain that alcohol use disorder is a disease, and that it can be treated. Suggest a few treatment centers in your area that may be a good fit for your loved one.

Self-Test: Am I a High-Functioning Alcoholic?

If you recognize any of the signs and symptoms of a high-functioning alcoholic we have outlined above in yourself or your loved one, it is recommended that you ask yourselves the questions provided below. If you or your loved one answer in the affirmative to two or more of these questions, you may be dealing with alcohol use disorder:2

• Did I ever drive, care for small children, operate hazardous machinery, or otherwise perform sensitive tasks while under the influence of alcohol?
• Have I ever done unlawful things as a result of my drinking (ie., driving while intoxicated)?
• Did I ever feel guilty about how much I drink?
• Have I ever tried and failed to reduce my alcohol consumption?
• Have I ever lied to others about my drinking or claimed that I never drink, despite doing so regularly?
• Do I feel tense, insecure, or anxious when I am not drinking?
• Did I ever have an argument with a loved one over my drinking?
• Have I ever tried to get friends or loved ones to help me conceal my alcohol use, such as by asking them to call into work to report that I am ill when I am actually hungover?
• Did I ever experience memory loss (eg., a blackout) as a result of my drinking?
• Have I ever missed, or been severely late to, school or work because of my alcohol use?
• Did any of my friends or family members break contact with me because they do not agree with my drinking habits?
• Did I ever become angry because someone criticized my drinking or called attention to it?
• Have others expressed concern about my drinking or advised me to drink less alcohol?
• Did I ever attempt to hide my drinking, such as by calling in sick when I am really hungover?

What are the Treatment Options For High-Functioning Alcoholics?

Research into alcohol use disorder, and addiction in general, has shown that no two substance use disorders are quite the same. This is especially the case when an individual also suffers from one or more co-occurring mental health disorders that may have caused them to develop an AUD in the first place, or were caused or exacerbated by their AUD.7,9

To increase the likelihood of achieving long-term sobriety, each patient needs to be given a comprehensive intake assessment and provided with personalized treatment that is in line with their particular needs and circumstances. Understanding what a specific treatment plan entails is key to finding one that is right for yourself or your loved one. For instance, some patients are best served by gender-specific rehab programs, while others require specialized approaches that are aimed at groups such as war veterans, pet owners, and homeless individuals.9

Evidence-based treatments for AUD include:

• Detox. Unless the patient’s AUD is very mild, they will likely need to go through a detox program that is designed to rid their body of toxins and manage withdrawal symptoms. Depending on the severity of the patient’s AUD, their detox program may or may not be medically assisted.9
• Outpatient treatment allows the functioning alcoholic to live at home during treatment, and is typically recommended to individuals who were diagnosed with mild AUD, and/or who are not very likely to relapse, and/or who are unable or unwilling to be hospitalized.9
• Inpatient treatment requires the patient to live at a rehab center for the entire duration of treatment. This ensures 24/7 monitoring, high-intensity care, and is typically recommended to individuals who have a history of relapse or who suffer from severe AUD. Inpatient treatment can last anywhere between 28-30 days to multiple months and even years.9
• Individual therapy includes recurring one-on-one meetings between the patient and a therapist. They are designed to help the patient understand the causes of their AUD and learn coping mechanisms that help limit the possibility of relapse.9
• Group therapy includes regular meetings between groups of patients who have similar AUDs. These sessions are led by a mental health professional, and designed to help individuals discuss their experiences and support each other as they work through their problems.9
• Alcoholics Anonymous (AA) is a fellowship of individuals who follow a free 12-step program and work to help each other attain and maintain sobriety.10