High Functioning Alcoholics – Signs, Risks and Treatment Options
High functioning alcoholics are individuals who suffer from alcohol use disorder (AUD), while still being able to function in their personal and professional lives. Unlike regular alcoholics, who often find it difficult to keep their AUDs from interfering with work and relationships, high functioning alcoholics are able to keep their AUD hidden and to (for the time being) avoid severe infractions with the criminal justice system.1
Functioning alcoholics often appear “normal” to other people even while drinking heavily. They rarely lose control over their emotions or display significant personality changes while under the influence of alcohol. Despite seemingly being able to evade the consequences of copious drinking, these individuals may still be struggling with their addiction similarly to those who suffer from more overt and immediate symptoms of substance use disorders (SUDs).2
What Is a High Functioning Alcoholic?
High functioning alcoholics differ from other individuals who battle AUDs and/or other SUDs due to their ability to keep their addiction hidden from the people in their personal and professional environments. They are also able to (at least initially) perform well at work, take care of their physical health, maintain a mask of normalcy, and avoid AUD-related problems with the law.1
Like many people who battle SUDs, functioning alcoholics tend to be in denial about the severity of their addiction. Due to their ability to seemingly keep their lives on track despite considerable alcohol intake, they are often even more likely to misattribute their problems to other factors, rather than their drinking behavior.3
They may often lie about their alcohol use, underestimate how much they drink, and refuse to admit the duration of their AUD or acknowledge the effects their alcohol consumption has had on their lives. Some functioning alcoholics may even maintain their denial when faced with inescapable realities, such as a liver disease diagnosis or a DUI (Driving Under Influence) charge.3
What Are the Symptoms of a High Functioning Alcoholic?
High functioning alcoholic signs can be difficult to identify. This is in part due to their ability to effectively hide or downplay their AUDs for extended periods of time, as well as their tendency to be in denial about the frequency and severity of their alcohol intake. Behaviors that may indicate an individual is suffering from high functioning alcoholism include:1, 2, 3
- Hiding or lying about how much alcohol they consume or how strong their drinks are.
- Concealing alcohol usage from family members, classmates, and coworkers.
- Drinking alone, hiding alcohol around their home, drinking after or before an event, and/or sneaking alcohol into events where alcohol isn’t served.
- Feeling a powerful need or urge to drink (cravings) in some situations.
- Obsessing over when they can have their next drink.
- Continuing to drink even after their AUD has caused or exacerbated one or more mental and physical health problems.
- Consuming alcohol at lunchtime during work or school.
- Drinking alcohol prior to driving, or in other situations where being intoxicated can be hazardous.
- Drinking to cope with stressful situations or as a reward for good performance.
- Experiencing a pressing urge to finish drinks, even if they belong to someone else.
- Consuming significant amounts of alcohol without appearing intoxicated.
- Evading or denying any feedback or critical input about their drinking patterns.
- Justifying their drinking by making comparisons to individuals who have had worse issues with drinking or experienced more severe consequences.
- Experiencing alcohol-induced blackouts.
- Developing a reputation for being able to do a great job at school or work despite excessive alcohol consumption.
What Are the Risks Factors of High Functioning Alcoholics?
Regardless of whether they are high functioning or non-functioning, alcoholics tend to experience a variety of physical and mental health issues that are caused or worsened by excessive alcohol use.4
Short-term health risks
When consumed in large amounts, alcohol can lead to temporary personality changes and loss of control that put the alcoholic and those around them in dangerous or unhealthy situations. Common risks associated with binge drinking include:4
- Alcohol poisoning.
- Injuries (falls, burns, drownings, motor vehicle crashes, etc.)
- Risky sexual behavior (unprotected sex, sex with multiple partners, etc.)
- Violent behavior (assault, suicide, homicide, familial violence, etc.)
- Stillbirth, miscarriage, or FASDs (fetal alcohol spectrum disorders) among pregnant individuals.
Long-term health risks
If left untreated, alcoholism may eventually lead to the development or exacerbation of various chronic illnesses and other severe health problems. These include:4
- Colon, esophagus, mouth, throat, breast, voice box, and rectal cancer.
- Liver disease, heart disease, high blood pressure, digestive problems, and stroke.
- Unemployment, family issues, job-related complications, and other social problems.
- Anxiety, depression, and other mental health issues.
- Weakened immune system (greater risk of getting sick).
- Alcohol use disorders (AUDs) or alcohol addiction.
- Dementia, poor performance in school, and other memory and learning issues.
How To Help a High Functioning Alcoholic?
If your loved one is struggling with alcohol use disorder, your first step should be to inform yourself about the subject of alcoholism and addiction before confronting them about their AUD. Understand that alcoholism is a disease, and that the afflicted individual may be unable to stop on their own.5
Next, research local or out-of-state rehab centers and learn about the different types of alcohol addiction treatment that are available. If you are not sure where to begin, call a dedicated alcohol use disorder hotline and discuss your situation with a qualified navigator. Apart from answering your questions and helping you explore treatment options, the navigator can also help you verify your or your loved one’s healthcare coverage and explain other ways to pay for treatment (or receive it for free).
How to Confront a High Functioning Alcoholic?
Once you have thoroughly informed yourself about AUD, it is time to have a conversation with your loved one about their alcohol use. Research has shown that the following approach has the highest odds of success:6
- Have the conversation in a private and peaceful setting, such as at home or during a walk.
- Inquire about their general feelings. Discuss your concerns gently, but honestly.
- Hear them out and provide emotional support. Don’t be harsh or judgmental.
- Explain that AUD is a disease and that it’s treatable. Discuss the possible treatment options.
- It usually takes time for a functioning alcoholic to overcome their denial and admit to the problem, so a single conversation is often not enough. Continue reaching out with offers to listen and help.
Self-test: Am I a Functioning Alcoholic?
If you or your loved one are exhibiting any of the symptoms of a high functioning alcoholic we discussed above, it’s strongly advised that you take the functioning alcoholic quiz outlined below. If a person honestly answers “yes” to two or more of these questions, it is probable that they are struggling with AUD:2
- Did I ever break the law or perform hazardous activities as a result of my alcohol consumption (eg., driving while inebriated, caring for young children, operating heavy machinery, etc.)?
- Does my alcohol use follow a specific routine? This may include only drinking alcohol at particular places or times, but in those situations, I am almost always consuming alcohol?
- Have I ever missed work or school as a result of my alcohol use?
- Have I ever unsuccessfully attempted to reduce the amount of alcohol I drink?
- Have friends or family members told me that I consume too much alcohol?
- Have I ever told someone I don’t drink alcohol, despite regularly doing so?
- Has my alcohol use caused me to suffer any infractions with the criminal justice system?
- Has my alcohol consumption ever made me feel guilty?
- Did I ever try to convince friends or family members to cover up for me in regards to my alcohol use (eg., asking them to call into work to report that I am sick when I am actually hungover)?
- Do I feel tense or insecure when I am not under the influence of alcohol?
- Have my alcohol habits caused me to lose contact with any family members or friends?
- Have I ever gotten angry when someone mentioned my alcohol consumption or criticized me for it?
- Did I ever try to conceal my alcohol usage (eg., calling in sick because my hangover prevents me from going to work)?
- Have I ever had an argument with a family member over my alcohol use?
- Have I experienced blackouts (lost memory) while drinking?
What Are The Treatment Options For High Functioning Alcoholics?
If you or a loved one are dealing with non-functioning or high functioning alcohol use disorder, it is strongly recommended that you look into the different recovery options available. Evidence has shown that there is no such thing as a universal cure for alcoholism. Every patient requires a personalized approach that meets their unique needs and situation.7
Evidence-based treatments for AUD that have been shown to significantly decrease the risk of a relapse include:7
This is a fellowship of individuals who have come together to solve their AUDs. They do not charge money, and have no age or education requirements. Their goal is to provide non-functioning and functioning alcoholics with a safe environment where they can share their stories and progress through a spirituality-based 12-step program.8
Outpatient treatment for alcohol use disorders enables patients to meet their work, school, or home obligations while undergoing addiction treatment. This type of treatment is normally recommended for individuals whose AUDs are mild, who have a supportive home environment, and who do not have a history of relapse.7
Inpatient programs are recommended to those who suffer from severe AUDs. They require patients to live at a rehab facility for anywhere between 3 days to a couple years (most inpatient programs last between 30 and 90 days). They usually include detox, 24/7 medical supervision, individual and group therapy, recreational activities, and comprehensive aftercare planning.7
Research has shown that a large percentage of individuals who struggle with AUDs also struggle with one or more co-occurring mental health disorders that may or may not have been caused or worsened by their AUDs. An individual that is diagnosed with both an AUD and a co-occurring mental health disorder is said to have a dual diagnosis. These patients require specialized care that is designed to tackle both co-occurring disorders.7, 9
The patient meets with a qualified therapist and tries to identify and resolve the underlying issues that have caused or exacerbated their AUD over the course of multiple one-on-one sessions. The non-functioning or high functioning alcoholic also learns coping strategies that can help them in trigger situations or while they are experiencing cravings.7
A group of patients who are battling similar AUDs gather together at a session led by a licensed mental health professional. This approach focuses on interpersonal interaction and the sharing of personal experiences.7
Frequently Asked Questions