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High-Functioning Alcoholic: Symptoms, Risks & Treatment

Last Updated: January 25, 2024

Editorial Policy | Research Policy

Broadly, the term alcohol use disorder can describe a spectrum of medical conditions characterized primarily by not being able to stop or control drinking. When you lose control over drinking patterns, it can create negative consequences in different areas of your life. Alcohol addiction is one of the most severe levels of an alcohol use disorder, but these disorders can also be mild or moderate. 

When people talk about alcoholism, they are actually referring to someone who has an alcohol use disorder. Alcoholism is not an official diagnosis, but it is a commonly used term. There are also subtypes of alcoholism, one of which is functional alcoholism.

A person who’s considered a “functional alcoholic” may outwardly seem like they have everything together, but they could be less apparently having problems controlling their drinking. Since alcoholism is a progressive disease and can worsen over time without treatment, early intervention is essential. Being able to recognize the warning signs of a functional alcohol use disorder can help you take the next steps toward treatment, or you might be able to help someone you love.

What Is a High-Functioning Alcoholic?

An alcohol use disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders or DSM-5, is a problematic pattern of behaviors related to alcohol use. When you have an alcohol use disorder, it causes impairment and distress. There’s a spectrum for diagnosis, including mild, moderate or severe. A diagnosis is based on how many symptoms you experience over the past 12 months, with 11 total criteria.

A “high-functioning alcoholic” isn’t a medical diagnosis but is usually a reference to someone with mild or moderate AUD. Someone with functioning alcoholism is still meeting most or all of their responsibilities and obligations at home and work. The consequences of alcohol use aren’t as severe in someone with functioning alcoholism, at least not at the moment.

A medical or addiction treatment professional can go over the symptoms someone is experiencing and assess where they could fall on the AUD spectrum. A mild AUD diagnosis includes two to three symptoms. A moderate AUD includes four to five symptoms, and a severe AUD includes six or more symptoms.

What Is Functional Tolerance?

The development of tolerance can occur when someone regularly uses alcohol. Tolerance is one of the signs used to diagnose an AUD, and it may be one of the earliest apparent symptoms. The term tolerance refers to a lowered effect of alcohol with repeated exposure. You might drink the same amount of alcohol as usual, but there’s less of an effect. A person with a tolerance may need to drink more to get whatever their desired effects are.

Functional tolerance contributes to addiction because you might be trying to feel what made you initially enjoy drinking, such as relaxation or euphoria. The more tolerant you are to the effects of alcohol, the more likely you are to have a faster progression to an alcohol use disorder.

Signs You or a Loved One is a Functioning Alcoholic

A “functioning alcoholic” can be a vague term, with different meanings in different situations, but broadly, some of the signs of functional alcoholism or problematic drinking patterns can include:

  • You or a loved one are using alcohol as a coping tool for problems or stress in different areas of life.
  • There’s a setting of arbitrary limits for drinking. For example, maybe you or a loved one often say you’re going to avoid liquor and only drink beer for the night. You could be trying to create the illusion of control over your drinking when, in fact, you’re losing a sense of control over it.
  • A sign of functioning alcoholism is regularly getting drunk without meaning to. For example, you may get intoxicated every time you go for drinks with friends.
  • You or your loved one use any occasion, whether good or bad, as a reason to drink.
  • You’re experiencing blackouts or lapses in your memory.
  • Denial or hiding alcohol use can be a sign of problematic patterns of use.
  • You might find that you’re isolating yourself more so that you can drink without other people knowing it.
  • You or your loved ones make frequent jokes about your alcohol use.
  • Feelings of shame are starting to occur.
  • You compartmentalize your drinking from other parts of your life.

There are a lot of shared traits between functional alcoholism and more severe problems with alcohol, so it’s important that you talk to a healthcare professional or encourage your loved one to do so.

Why Early Intervention Is Important

If you use alcohol, especially regularly, it begins to affect your brain structurally and functionally. Alcohol and other addictive substances activate the areas of your brain that are part of your reward system. Over time, you may drink not because you’re choosing to but because you’ve developed an addiction, and your use is compulsive due to effects on your brain. 

The earlier an intervention is sought, the better the outcomes for many people. Also, if you seek help for yourself or a loved one early on, outpatient rehab can be effective. On the other hand, waiting may require a more intensive level of care. If you’re unsure where to begin, a primary care provider can be a good resource in the earliest stages of diagnosing an alcohol use disorder.

How to Help a High-Functioning Alcoholic

Many resources are available, whether you want to help yourself or someone you care about. For some people, as mentioned, the first resource could be speaking to their primary care provider, who can help them understand the next steps. There are also peer support groups that include 12-step programs like Alcoholics Anonymous, as well as other options like the SMART Recovery program. If someone has a milder substance use disorder, participation in a group like this can be helpful.

If you’re trying to help someone you love, speaking to them openly and honestly can be one of the best things to do early on. The person may not realize there’s such an issue that others have noticed, and a conversation free of judgment can bring about more awareness. 

Depending on the situation’s specifics and your concern, you could also work with a professional addiction treatment center or interventionist to arrange an intervention. During an intervention, loved ones come together to share how someone’s drinking is affecting them and show their support if the person decides to get help.

Treatment Options for High-Functioning Alcoholics

There are treatment options for people dealing with any level of an alcohol use disorder, whether it is mild, moderate or severe. This includes functional alcoholism. The highest level of care is typically a residential program with a structured, on-site living environment. This is often what’s best for someone with a more severe or long-term alcohol use disorder or a co-occurring mental health disorder. 

For someone who’s high-functioning in their alcohol addiction, another viable option could be an outpatient program. Outpatient programs offer more flexibility regarding the schedule but provide the support and recovery resources needed. Other options that could be part of treatment for high-functioning alcohol use disorder include group or individual therapy and participation in support groups.

To learn more about addiction treatment and recovery resources, please contact a Recovery Advocate at The Recovery Village Atlanta Drug and Alcohol Rehab today.

Sources

NIH National Institute on Alcohol Abuse and Alcoholism. “Alcohol’s Effects on Health.” December 2023. Accessed January 16, 2024.

NIH National Institutes of Health. “Researchers Identify Alcoholism Subtypes.” June 28, 2007. Accessed January 16, 2024. 

NIH National Institute on Alcohol Abuse and Alcoholism. “The Cycle of Alcohol Addiction.” 2021. Accessed January 16, 2024. 

NIH National Institute on Alcohol Abuse and Alcoholism. “Alcohol Use Disorder: From Risk to Diagnosis to Recovery.” September 22, 2023. Accessed January 16, 2024. .

Elvig, Sophie K. et al. “Tolerance to Alcohol: A Critical Yet Understudied Factor in Alcohol Addiction.” NIH National Library of Medicine, May 1, 2022. Accessed January 16, 2024. 

Dubey, Michelle, LCSW, LISW, CCTS. “15 Signs of a High-Functioning Alcoholic.” Nevada Bar Association, January 2022. Accessed January 16, 2024. 

Spithoff, Sheryl, MD CCFP, et al. “Primary care management of alcohol use disorder and at-risk drinking.” NIH National Library of Medicine, June 2015. Accessed January 16, 2024.