What is a “High-Functioning” Alcoholic?
People are impacted by their compulsive or otherwise problematic patterns of drinking in different ways. Many of those who struggle with severe alcohol use disorder are unable to function well in their daily lives, while others—sometimes informally referred to as “high-functioning alcoholics”—may seem more able to maintain a semblance of normal life by continuing to perform and succeed in their careers or other tasks. To varying extents, they may also be able to maintain relationships and physical health and may have been fortunate enough to have so far avoided any serious infractions with the criminal justice system.1,2
Unfortunately, there isn’t much research on people suffering from functional addictions, primarily because they are less likely to seek treatment for any of the potential problems they encounter in relation to their drinking. 2
Functional alcoholics may seem “normal” to other people, even while under the influence, and may appear to have a higher tolerance for alcohol. They may not experience overt blackout episodes, display significant personality changes, or lose control of their emotions due to alcohol use.2 In some cases, an element of luck may be at play to explain how a more functional alcoholic has seemingly dodged some of the consequences of their problematic drinking; however, these people may still be fundamentally struggling with an addiction similarly to those with more immediate or recognizably debilitating issues.2
What Part Does Denial Play in Alcoholism?
Denial is a component of many people’s drinking problems, and it may be even more pronounced among high-functioning alcoholics. People who are able to maintain their relationships and jobs, avoid substance-related criminal or legal entanglements, and not experience serious health problems may find it more easy to deny a problematic component to their drinking behavior.2
Yet, denial can be a tremendous barrier to people suffering from alcoholism because they may not want to, or be able to, admit that they have a problem.3 People who are in denial may lie about their alcohol use, underestimate the amount they use, and fail to admit to the duration of their problem or acknowledge the full impact that their alcohol abuse has had on their lives.3
When confronted with an unavoidable reality, such as a DUI or a diagnosis with liver disease, some people’s denial can be broken, but for others, it remains a permanent fixture despite the realities around them.3 Regardless, admitting to a problem and embracing one’s need for help can be crucial for successful recovery, and are key reasons why the first step in Alcoholics Anonymous is admitting to being powerless over alcohol.
Does Tolerance Contribute to Alcoholism?
When people continue to drink excessively, they may eventually need increasing amounts of it to experience its sought after intoxicating effects. This is known as tolerance and is a physiological process that develops even in seemingly high-functioning alcoholics. Tolerance develops when the brain adapts to alcohol’s persistently disruptive action on behavior and physical functioning.4
People with a lower tolerance (such as those who do not frequently drink alcohol) can become buzzed or intoxicated after a few drinks, whereas those with high tolerances may require several drinks to experience the same feelings.4 A high tolerance can be affected by a number of factors, such as:5,6,7
- The amount you drink and the speed at which you consume alcohol.
- Genetics and genetic enzyme deficiencies, meaning you have less of the enzymes that help your body process alcohol.
- Gender; women have fewer of the enzymes that metabolize alcohol than men do.
- Your body size and composition (i.e., body fat percentage).
- Ethnicity; people of Asian or Native American descent tend to have lower levels of the enzyme that metabolizes alcohol.
Tolerance can be a risk factor for both developing and maintaining alcohol addiction because you need to keep increasing the amount you drink to experience alcohol’s pleasurable effects. Additionally, developing a significant degree of functional tolerance could mean that a person may be able to perform some tasks after consuming alcohol while being impaired in performing others.4
Individuals can also developed a learned tolerance in which they perform tasks under the influence and therefore become adept at doing this same task going forward while intoxicated.4 For high-functioning alcoholics, this could mean that if they drink alcohol during the day while at work, they may develop a learned tolerance which allows them to function normally at work still. As a result, being able to fulfill job duties adequately does little to discourage them from continued patterns of alcohol abuse.
Do They Experience Withdrawal?
Although developing a tolerance for alcohol can contribute to increasingly problematic patterns of drinking, its presence alone does not necessarily signify that a person is struggling with alcoholism. However, as drinking patterns escalate, people become more likely to develop physiological alcohol dependence, which subsequently increases their risk of an associated alcohol withdrawal syndrome when they stop or reduce their drinking.8
Alcohol withdrawal can be dangerous because of the accompanying psychological and physical distress and/or life-threatening symptoms (some of which may require medical attention).9 Symptoms of withdrawal may occur as soon as 8 hours after the last drink, and usually peak in severity by 24 to 72 hours.10
Symptoms may include:10
- Anxiety or nervousness.
- Mood swings.
- Not thinking clearly.
- Increased heart rate.
The fear of experiencing these uncomfortable symptoms can also be a reason why some functioning alcoholics choose to continue drinking or relapse soon after attempting to quit or cut back on their alcohol intake.8 If you or someone you care about experiences symptoms of withdrawal, it may point to signs of a more serious problem.
Warning Signs of Alcoholism
Alcohol use disorder (AUD) is a clinical, diagnostic term for alcoholism. AUD is a chronic, relapsing disease characterized by a loss of control over alcohol use, leaving someone unable to stop drinking despite the negative impact on their health and ability to function.11
Alcohol is one of the most commonly used substances in the world and abuse can lead to mental and physical suffering or even death. According to the 2018 National Survey on Drug Use and Health, 14.4 million adults aged 18 and over had a diagnosis of AUD.12 It has been estimated that nearly 90,000 alcohol-related deaths occur each year, making alcohol the third leading cause of preventable death in the U.S.12
Whether you feel you may have a drinking problem or think someone else in your life may be struggling with alcohol, it can be important to spot the signs of addiction before it progresses. According to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), some signs and symptoms of AUD include:13
- Drinking more alcohol than you originally intended.
- Being unable to cut down your alcohol intake.
- Spending a lot of time trying to obtain, use, and recover from the effects of alcohol.
- Cravings, or feeling strong urges to drink alcohol.
- Being unable to meet obligations at home, school, or work due to alcohol use.
- Continuing to use alcohol despite ongoing social or interpersonal problems caused by alcohol use.
- Giving up activities you once enjoyed because of alcohol use.
- Using alcohol in situations where it is hazardous to do so (e.g., driving or operating machinery).
- Continuing to drink despite knowing that you have a physical or mental health issues related to your alcohol use.
- Experiencing symptoms of withdrawal.
- Developing a tolerance.
If you meet at least 2 of the above criteria within a 12-month period, you may want to consider undergoing a more formal assessment to see if AUD could be an issue.
Help a Functioning Alcoholic
It can be hard to talk about alcoholism with your loved one who’s struggling with alcoholism. But there are a few steps you can take to broach the subject of treatment and prepare not only them, but yourself for a conversation about alcoholism and addiction. Consider the below when trying to help a functioning alcoholic:
- Learn about alcoholism: Spend time reading about the disease of alcoholism so you can better understand what they are going through. The American Society of Addiction Medicine (ASAM) explains that alcoholism is a disease, meaning that although people choose to drink initially, once addicted, it may be out of their control to quit.
- Research alcohol addiction facilities: Next, look into local or out-of-state facilities and ask questions about treatment, their approach to addiction, amenities and any other needs your loved one may have. Be prepared with this information to share with them to lighten the load of finding a place on their own.
- Choose a time to talk: Choose a time to talk with your loved one when they are sober and in a place in which they are comfortable. Because a functioning alcoholic may not be showing tangible signs of addiction, they may not immediately be receptive to admitting that they have a problem. It may take a few conversations before they are willing to discuss treatment, so be open to keeping the lines of communication open.
- Show support during and after treatment: If they are ready to seek treatment and enter into rehab, you can continue to support their recovery efforts by joining groups such as Al-Anon, a mutual support group for families of those addicted to alcohol. Following treatment, show support by engaging in new activities with them or help them find new hobbies that no longer involve alcohol.
When Should You Seek Help?
It’s never too late to seek help for alcoholism and addiction. Even if you feel that you are still in control of your life and your work or relationships aren’t visibly suffering, a relatively mild alcohol use disorder could already be affecting your mental and physical health. Left unmanaged, compulsive drinking behaviors can get progressively worse, with their negative impact on your life becoming ever more apparent.
If you or someone you care about are experiencing any of the warning signs listed above, you should consider taking the first steps toward entering a professional treatment program. According to the National Institute on Alcohol Abuse and Alcoholism, “one-third of people who are treated for alcohol problems have no further symptoms 1 year later,” while others can significantly reduce their drinking and experience fewer problems due to alcohol use.14
Treatment for alcoholism should be tailored to your specific needs and should take into account your medical, psychological, social, vocational, and legal problems, as well as your age, ethnicity, gender, and culture.15 The alcohol rehab process usually starts with a supervised, medical detox and then continues with a formal inpatient or outpatient treatment program, which involves a combination of behavioral therapies, counseling, medication, and skills training to avoid relapse in the future.15
If you’re ready to seek treatment for alcoholism or would like to know more about your treatment options, American Addiction Centers (AAC) can help. AAC is the parent company of Alcohol.org and is a nationwide provider of treatment facilities focused on providing hope and recovery for those in need.
We are dedicated to making alcoholism treatment accessible to every person in need and our admissions navigators are available 24/7 to discuss your options. All calls are 100% confidential. Fill out the form below to see if your insurance covers treatment within an AAC facility now.
. Benton, S. (2009). Understanding the High-functioning Alcoholic: Professional Views and Personal Insights. Westport, CT: Greenwood Publishing Group.
. Fisher, G. (2011). Understanding Why Addicts Are Not All Alike: Recognizing the Types and How Their Differences Affect Intervention and Treatment. Santa Barbara, CA: ABC-CLIO, Inc.
. Rinn, W., Desai, N., Rosenblatt, H. & Gastfriend, D. (2002). Addiction denial and cognitive dysfunction: a preliminary investigation. The Journal of Neuropsychiatry and Clinical Neurosciences. 14(1), 52-57.
. National Institute on Alcohol Abuse and Alcoholism. (1995). Alcohol Alert No. 28 PH 356.
. NHS. (2010). Genes ‘affect alcohol tolerance’.
. Stanford University Office of Alcohol Policy and Education (n.d.). Factors that affect how alcohol is absorbed & metabolized.
. Bowling Green State University Department of Recreation and Wellness (n.d.). Factors that affect intoxication.
. 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.
. Bayard, M., Mcintyre, J., Hill, K. & Woodside, J. (2004). Alcohol withdrawal syndrome. American Family Physician, 69(6), 1443-1450.
. MedlinePlus. (2019). Alcohol Withdrawal.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol use disorder.
. National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol facts and statistics.
. American Psychiatric Association. (2013). Diagnostic And Statistical Manual Of Mental Disorders (5th ed.), 490-492.
. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for alcohol problems: Finding and getting help.
. National Institute on Drug Abuse. (2018). Principles of Effective Treatment. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).