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What is a Functioning Alcoholic?

Clinically Reviewed by:
Lindsey Rae Ackerman, LMFT

Written by:
Alex Salman, MPH on August 9, 2024

When we think about struggling with alcohol, one usually pictures someone whose life is falling apart. While this certainly can be the case in many instances, the term functional alcoholism (or functioning alcoholic) describes individuals who, despite heavy alcohol use, maintain a general facade of normalcy around their struggle.[1] Although the term alcoholic is typically no longer used, this kind of addiction highlights the complexity of alcohol use disorder and alcohol abuse, emphasizing the importance of recognizing and addressing it even when the outward appearance suggests stability. Functional alcoholism may involve individuals meeting daily responsibilities while denying the severity of their drinking problem, emphasizing the need for nuanced understanding and support in addressing alcohol-related concerns.

Today, Clear Behavioral Health will explore the concept of high-functioning alcoholism, examining the need for a more-nuanced perspective at how addiction can look and be defined.

What is Alcohol Use Disorder?

Alcohol use disorder (AUD) is a chronic medical and mental health condition characterized by a person’s inability to control or stop their drinking patterns despite negative consequences. This problematic pattern of alcohol use can lead to impairment in several areas of life, including negatively impacting your physical health, mental well-being, and overall social functioning.[2]

The diagnosis of alcohol use disorder is typically based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which includes symptoms such as:

  • A lack of control: The inability to cut down or control alcohol consumption
  • Social impairment: Alcohol use leading to problems in relationships, work, or other social obligations
  • Risky use: Continued alcohol use despite knowing it’s causing or exacerbating physical or psychological problems
  • Tolerance: Needing more alcohol to achieve the desired effect
  • Withdrawal symptoms: Experiencing physical or psychological symptoms when not consuming alcohol
  • The severity of AUD can range from mild to severe, depending on the number of symptoms present.[3]

What are the Signs of Alcohol Abuse?

Alcohol abuse refers to a pattern of drinking that leads to harmful consequences, but it may not meet the criteria for a diagnosis of Alcohol Use Disorder. Signs of alcohol abuse can vary, but they often include:

  • Regular excessive drinking: Consuming alcohol in larger amounts or over a more extended period than intended
  • An inability to cut down: Unsuccessful attempts to cut down or control alcohol consumption
  • Neglecting your responsibilities: Failing to fulfill obligations at work, school, or home due to alcohol use
  • Legal issues: Involvement in legal problems related to alcohol use, such as driving under the influence or public intoxication
  • Social and interpersonal issues: Experiencing relationship issues or social conflicts due to alcohol use
  • Engaging in risky behavior: Participating in activities that are dangerous or risky while under the influence of alcohol, such as operating a vehicle, using other substances, or having unprotected sex
  • Physical signs: Experiencing physical symptoms such as slurred speech, impaired coordination, memory lapses, or blackouts

Alcohol abuse can have serious health and social consequences and can progress to an alcohol use disorder or alcohol addiction if left unaddressed. If you or someone you know is exhibiting signs of alcohol abuse, seeking help from a healthcare professional or substance abuse counselor is recommended. Early intervention can help to prevent the development of more severe problems associated with alcohol misuse.[4]

What are the Signs of Alcohol Dependence and Alcohol Withdrawal?

Alcohol dependence is characterized by physical and psychological dependence on alcohol. Signs of alcohol dependence and withdrawal can include:

Alcohol Dependence

  • Tolerance: Needing increased amounts of alcohol to achieve the desired effect or experiencing diminished effects with continued use of the same amount
  • Preoccupation with drinking: Spending a significant amount of time obtaining, using, and recovering from the effects of alcohol
  • Neglecting responsibilities: Prioritizing drinking alcohol over obligations at work, school, or home
  • Withdrawal symptoms: Experiencing withdrawal symptoms when attempting to cut down or stop drinking[5]

Alcohol Withdrawal

  • Tremors: Shaking or trembling, usually in the hands
  • Nausea and vomiting: Feeling sick to the stomach and vomiting
  • Sweating: Profuse sweating, even in cool environments
  • Anxiety: Feeling nervous or restless
  • Irritability: Being easily agitated or angered
  • Insomnia: Difficulty falling or staying asleep
  • Increased Heart Rate: Palpitations or a rapid heartbeat
  • Hallucinations: Seeing, hearing, or feeling things that are not present
  • Seizures: In severe cases, alcohol withdrawal can lead to seizures

In some cases, alcohol withdrawal can be life-threatening. It’s critical for people who are dependent on alcohol to seek medical help when quitting, as a supervised detoxification process can help manage withdrawal symptoms and reduce the risk of any potential complications. Medical professionals can provide appropriate care, support, and, if necessary, prescribe medications to ease the withdrawal process.[6]

What is Functioning Alcoholism?

Functioning alcoholism, often referred to as high-functioning alcoholism, is a colloquial term used to describe individuals who manage to maintain a semblance of normalcy in their lives despite grappling with alcohol use disorder or alcohol abuse. Unlike the conventional image of alcoholism—which is itself an outdated term—that involves visible dysfunction and impairment, those classified as a functional alcoholic are usually able to successfully navigate their daily responsibilities, hold down jobs, and sustain relationships, creating the appearance of a well-adjusted life.[7]

Denial often plays a significant role for high-functioning alcoholics, as they may downplay or completely deny the severity of their drinking problem and cite their ability to meet other responsibilities in their defense. The external successes they achieve may serve as a defense mechanism, reinforcing the belief that their drinking is therefore not problematic.

High tolerance is another common characteristic, allowing functional alcoholics to consume substantial amounts of alcohol without displaying obvious signs of intoxication. Covert or secretive drinking is not uncommon, as individuals go to great lengths to conceal the extent of their alcohol consumption from those around them. Despite the appearance of functionality, functioning alcoholics may still suffer negative physical and mental health effects due to their drinking habits, even if they are not overt.[8]

Rationalization often accompanies this behavior for those struggling, justifying their drinking as a response to stress, a coping mechanism, or other external factors. It’s important to recognize that even though people fitting this definition may outwardly succeed in various aspects of life, the risks and harm associated with alcohol misuse still persist. As such, functioning alcoholics remain susceptible to the development of more severe alcohol-related problems if their patterns of drinking continue.

When to Seek Help

Seeking help for alcohol-related concerns is essential when an individual recognizes or experiences any signs of problematic alcohol use or when family members and others around them notice such signs. It’s important to be proactive in addressing alcohol-related issues to prevent the potential escalation of problems

The spectrum of care for alcohol-related concerns ranges from early interventions to comprehensive treatment programs:

Self-Help and Support Groups

Joining self-help groups like Alcoholics Anonymous (AA) can provide a supportive community for individuals seeking to reduce or quit alcohol use.

Counseling and Therapy

Individual or group counseling with a mental health professional can address underlying issues and provide coping strategies.

Outpatient Treatment

Outpatient programs offer more intensive support than counseling, providing structured treatment sessions while allowing individuals to continue with their daily lives.

Withdrawal Management

For many entering the recovery process, addressing any current or potential withdrawal symptoms is crucial. Withdrawal management, or detox, ensures a safe transition, providing medical support for symptoms, ranging from discomfort to severe manifestations.

Inpatient or Residential Treatment

For more severe cases of alcohol use disorder or alcohol abuse, inpatient or residential treatment involves staying in a facility for an extended period to receive intensive therapy and support.

Medication for Alcohol use Disorder

Certain medications, prescribed under medical supervision, can help manage cravings and withdrawal symptoms.

Aftercare and Relapse Prevention

After completing a formal addiction treatment program, ongoing aftercare and relapse prevention strategies are important for long-term recovery, continuing your connection to a recovery community and your care providers.

Determining the appropriate level of care depends on the severity of the alcohol-related concerns and the individual’s unique needs. Consulting with healthcare professionals, addiction specialists, or mental health providers can help in creating a personalized plan for addressing alcohol-related issues and supporting recovery. Early intervention is often key to preventing the progression of alcohol use disorders and promoting overall well-being.

Start Your Recovery at Clear

Clear Behavioral Health offers a full spectrum of care for all addiction-related concerns, providing individualized solutions for those grappling with alcohol use, substance use disorders, and co-occurring mental health concerns. Our team is committed to understanding your unique needs and guiding you towards a path of lasting recovery, and we’re in-network with most major insurance providers.

Take the first step towards a healthier future by reaching out to Clear Behavioral Health to learn more about our detox, withdrawal management, and residential addiction treatment as well as our outpatient programs for co-occurring disorders. Your journey to recovery begins here.

References:

Mental Health Services and Addiction Treatment in Los Angeles
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