High-Functioning Alcoholic: What It Means, Warning Signs and How to Get Help

Many people view a “high-functioning alcoholic” as someone who appears to be fully capable of caring for themselves and their family.[1] However, the appearance of capability does not indicate actual capability. A high-functioning alcoholic can continue to meet expectations of employment, family obligations, and community commitments while engaging in a manner of drinking that ultimately results in harm to their bodies, mental health, or interpersonal relationships.

While many clinicians refer to the term “high functioning alcoholic” to describe an individual who continues to drink excessively while maintaining outward capabilities, there is no formal medical diagnosis known as “high functioning alcoholic.”[2] Clinicians diagnose an individual as having alcohol use disorder (also referred to as AUD).

Functioning Alcoholism and Alcohol Use Disorder

Functioning alcoholism is a descriptive term to explain how an individual’s alcohol use disorder may manifest from an outsider’s perspective. A high-functioning alcoholic is simply a more accurate descriptor of how someone with alcohol use disorder may present to others. While some individuals with AUD exhibit overt negative consequences resulting from their behavior (e.g., job loss due to missed work, incarceration due to drunk driving), others may have sufficient structural components in place to mask the symptoms until those same symptoms eventually surface. For example, some individuals with AUD may experience praise regarding their productivity, social interactions, etc., regardless of their increasing dependency on alcohol.

Functioning alcoholism may result in delayed treatment. Many people believe that since they continue to fulfill their duties as employees, parents, spouses, etc., they cannot possibly have a drinking problem. Additionally, family members may fail to intervene due to the fact that their loved one appears to be functioning. Functionality can fluctuate. A person may appear to be functioning normally for extended periods of time before they begin to show signs of physical or emotional withdrawal symptoms, relationship damage, etc., that ultimately reveal their dependency on alcohol.

Warning Signs of High Functioning Alcoholism

Identifying an alcoholic can be challenging when the individual appears to be functioning normally. Rather than focusing solely on visible indicators of dysfunction (e.g., unemployment, divorce), examine the patterns associated with the individual’s behavior.

Examples of potential warning signs include:

• Drinking nightly or most nights
• Frequently consuming greater quantities than desired
• Using alcohol to relax, sleep, socialize, or feel normal
• Engaging in solitary drinking or hiding bottles or drink containers
• Joking about needing alcohol
• Becoming irate when denied access to alcohol
• Exhibiting elevated levels of tolerance to alcohol
• Experiencing blackouts or memory lapses
• Demonstrating extreme fluctuations in moods, depression, or anxiety post-consumption
• Ignoring responsibilities (due to hangover)
• Prioritizing consumption over other interests, family time, or health objectives
• Denying the existence of a drinking problem due to apparent stability in work, school, or family life
• Continuing to consume despite adverse effects on health, taking prescribed medications, or advice from concerned family or loved ones

One indicator does not confirm the presence of AUD. The accumulation of multiple indicators along with failure to abstain from consumption indicates the need for intervention.

Reasons Why High Functioning Alcohol Consumption Can Be Underestimated

Individuals with functioning alcoholism often possess compelling arguments against recognizing their problem. Some view alcohol as the ultimate reward for working hard. Others view drinking as merely a means of reducing private stress or a means of social interaction or relaxation. Similarly, family members may underestimate the severity of their loved one’s consumption. For example, they may rationalize their loved one’s consumption by stating that “they aren’t missing work,” or “they don’t drink nearly as much as _______,” etc. However, comparing consumption rates among peers is never an effective method for measuring harm caused by consumption.

Heavy drinking can produce a multitude of negative consequences prior to any visible public debacle occurring. Examples include changes in sleep patterns, mood, energy, decision-making, interpersonal relations, and physical health.

Consequences of Untreated High-Functioning Alcoholism

Untreated AUD can escalate in severity over time. According to the Centers for Disease Control and Prevention (CDC), excessive alcohol consumption increases the risk of injury, alcohol poisoning, liver disease, heart disease, high blood pressure, certain types of cancer, mental illness, and AUD itself [3].

Possible outcomes associated with untreated high-functioning alcoholism include:

• Increasing depression or anxiety
• Disrupted sleep
• Gradual elevation of tolerance
• Symptoms associated with withdrawal (between episodes of consumption)
• Conflict in relationships
• Stress related to parenting or family dynamics
• Decreased ability to perform at work over time
• Injuries or accidents
• Poor decision-making while intoxicated
• Economic difficulties stemming from consumption
• Cirrhosis, liver disease, hepatitis, cancer, or heart disease
• Increased likelihood of developing certain cancers

As previously stated, AUD often co-exists with other mental health disorders. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that AUD and mental health disorders frequently coexist and that treating psychiatric symptoms without concurrently addressing consumption will likely yield inadequate reductions in consumption or AUD symptoms [4].

The aforementioned information highlights the importance of seeking treatment prior to allowing these two factors to continue feeding off one another.

How to Support a Loved One With High Functioning Alcoholism

Supporting a loved one with AUD can be emotionally taxing, especially when they do not acknowledge the severity of their problem. You cannot force insight onto anyone, but you can act in a manner that makes denying reality increasingly more difficult.

Begin by initiating a calm, concrete dialogue rather than launching into a heated debate surrounding the topic of labeling (“you’re an addict”) or debating semantics regarding various definitions. Instead, focus on what you have observed concerning their behavior.

Example statements that illustrate this concept include:

• “I am worried because you have been drinking nightly and appear tired in the mornings.”
• “I’ve seen you try to decrease consumption, but you typically resume immediately.”
• “I’m concerned because you appeared disoriented or incoherent during portions of last evening.”
• “I love you, and I believe this issue is larger than you realize.”

Do not argue over labels such as “addict” versus “alcoholic.” Labels can become distractions. More importantly, discuss what is happening, how their consumption is impacting daily routines, and what forms of professional assistance are available.

Additional strategies include:

• Not attempting to conceal evidence of consumption-related consequences
• Setting limits or guidelines for acceptable behavior
• Assisting research efforts surrounding treatment options
• Recommending assessments by qualified healthcare providers
• Suggesting participation in support groups for them or for yourself

Seek immediate medical assistance if the individual is exhibiting withdrawal symptoms such as:
Severe anxiety, shakiness, sweating, nausea, hallucinations, mental confusion, delusions, or seizures

Detoxification with medical supervision may be necessary when an individual experiences withdrawal symptoms due to cessation of consumption.

Treating High Functioning Alcoholism

At Epiphany Wellness, we provide individualized alcohol use disorder treatment for people who are struggling to control their drinking, manage cravings, or reduce their alcohol use. We also support clients experiencing co-occurring mental health conditions through evidence-based treatment, holistic interventions, and personalized care.

If alcohol use, cravings, withdrawal symptoms, or difficulty cutting back have begun to interfere with your health, relationships, work, or daily life, you can contact our admissions team to discuss treatment options and determine an appropriate next step.