High functioning alcoholic: What to know

A person who appears to be managing their alcohol intake but is experiencing issues with their relationship to alcohol has what is now known as an alcohol use disorder (AUD).

The National Institute on Alcohol Abuse and Addiction (NIAAA) defines excessive alcohol use as:

• binge drinking — consuming four or more alcoholic beverages for women, and five or more alcoholic beverages for men in one sitting
• heavy drinking — for women, consuming more than three alcoholic drinks on any day or seven or more in a week, and for men, consuming more than four drinks on any day or 14 or more in a week
• any alcohol drinking by pregnant people or anyone younger than 21 years

Due to some people’s ability to mask their AUD, it is difficult to find research on those that are high functioning. However, the AAC highlights a study that estimates at least 20% of people with AUDs are high functioning, while other studies suggest that as many as three-quarters of people with AUDs are able to function at a high level in some areas of their life.

The AAC highlights a series of signs that may suggest a person is high functioning while maintaining what appears to be a successful career, family life, or social life:

• avoiding critical feedback about drinking patterns
• blacking out from alcohol consumption
• irritability and extreme mood swings
• concealing alcohol consumption — for example, hiding empty bottles, covert drinking before events, drinking alone, and hiding alcohol
• drinking substantial amounts of alcohol without appearing to be intoxicated
• drinking during inappropriate situations, for example, at work
• finishing other people’s drinks
• feeling guilty or ashamed after periods of drinking
• trying — and failing — to control alcohol consumption
• experiencing strong cravings for alcohol when not drinking
• drinking in potentially dangerous situations, for example, before driving

It is important to note that these signs may not be obvious to a loved one or friend. This is because people can be skillful at hiding the signs of an issue with alcohol.

People who are not considered “high functioning” in relation to their alcohol use disorder are more likely to:

• continue to drink, despite significant negative effects on their life
• become emotionally and physically isolated from friends and family
• be physically addicted to alcohol
• give up activities and routines in favor of drinking
• change their appearance due to drinking excessive amounts
• admit they have a problem with drinking
• exhibit risky or dangerous behavior while drinking
• have more obvious withdrawal symptoms when not drinking alcohol
• break the law

The more a person drinks, the more at risk they are of developing severe alcohol use disorder. Early intervention is therefore vital.

Learn more about alcohol use disorder here.

Drinking excessive amounts of alcohol carries many risks. According to the Centers for Disease Control and Prevention (CDC), 95,000 people lose their lives every year due to excessive alcohol use.

Short-term risks include:

• injuries or accidents as a result of being intoxicated
• being a victim or a perpetrator of violence
• alcohol poisoning
• risky sexual behaviors, including sex without a condom or other barrier method
• for pregnant people, miscarriage, stillbirth, or fetal alcohol syndrome

Long-term risks include:

• developing a physical dependence on alcohol
• high blood pressure, cardiovascular conditions, and digestive issues
• a weakened immune system, increasing the risk of infection and disease
• issues with memory and learning
• mental health conditions, such as depression and anxiety

People who are concerned about their drinking habits, and those who are showing signs of an AUD, may wish to reach out for help and support. According to the NIAAA, the majority of people with an AUD can benefit from some form of treatment.

The NIAAA offers a range of assessment tools and strategies to help people understand their drinking patterns, reduce their drinking, or quit completely.

Recovered.org provides an anonymous online evaluation tool to check if drinking has become problematic and provides further resources for help and support.

Contacting a healthcare professional may also help. A doctor can check a person’s drinking levels and recommend further treatment options.

Treatment for AUDs can take several forms. Often a combination of treatments is the best approach.

The first step for most people is detox, which means quitting alcohol. A detox may take place at a hospital or inpatient facility, such as rehab.

If withdrawal symptoms are severe, a doctor may prescribe medication to reduce extreme agitation and hallucinations. These can include:

• benzodiazepines,such as diazepam or lorazepam
• anticonvulsants, including carbamazepine or topiramate
• antipsychotics, such as haloperidol

Sometimes, doctors prescribe medications that can help a person quit drinking to prevent relapse. These include:

• naltrexone, which reduces the urge to drink by blocking brain receptors
• acamprosate to reduce cravings
• disulfiram, which blocks the metabolism of alcohol in the body so that a person experiences unpleasant symptoms, such as nausea, if they drink alcohol

Once detox is complete, a person may transfer to a substance use disorder program.

It is also possible to detox as part of an outpatient program, which features varying levels of support and treatment.

Further treatment interventions may include:

• Behavioral therapies: This can include cognitive behavioral therapy and motivational therapy to identify unhelpful thought processes and encourage changes in behavior.
• Counseling with a partner or family members: Encouraging loved ones to attend therapy with the person with an AUD to support their recovery and rebuild relationships.
• Brief interventions: Attending short, individual counseling sessions for feedback and goal setting.

Recovery from alcohol use disorder can be a lifelong process. Many people with AUDs decide to have further treatment and support, such as attending group therapy, individual counseling, or support groups.

Learn more about alcohol detox here.

Certain factors may increase a person’s risk of developing an AUD. These include:

• drinking alcohol from an early age
• a family history of problem drinking
• mental health conditions, a history of trauma, or both

Peer pressure and easy availability of alcohol can increase the risk of developing an AUD. Negative life experiences, such as grief, abuse, or living in poverty, can also increase the odds.

More recently, a 2020 study found that people who used alcohol to cope with the COVID-19 pandemic were more likely to drink alone and drink to excessive amounts. Researchers cited further risk factors, such as having a child under 18 and at home, having depression, and having fewer social interactions due to the pandemic.

It can be very difficult for people to watch someone they care about experience an AUD. Family and friends may worry that pointing out risky drinking behaviors to the person may alienate them and risk further harm. The AAC recommends the following steps to reach out and connect with someone living with an AUD, as well as supporting oneself:

• learning about AUDs, and their signs and symptoms
• talking with a therapist, mental health specialist, or substance misuse specialist beforehand if possible
• preparing for the conversation by writing down the main points to discuss
• expressing feelings and concerns about the impact of the loved one’s drinking on themselves and others
• avoiding using labels such as “alcoholic” or “addict”
• practicing self-care and avoiding emotional dependence on a person with an AUD
• considering accessible treatment options and having them ready before a conversation or intervention
• avoiding ultimatums or demands
• participating in a loved one’s recovery by offering support, for example, attending counseling with them or also quitting alcohol

The term high functioning alcoholic is no longer in use in the medical community. However, some people may use the phrase to refer to individuals who are experiencing an AUD but are still able to successfully function in their work and personal lives.

Drinking excessive amounts of alcohol can impact short- and long-term physical and mental health. Getting help early on can reduce the risk of developing alcohol addiction.

It is important to know that an AUD is a chronic but treatable disease. Early intervention and treatment can help reduce the severity of the disease and prevent further physical or mental complications from developing.