You may have heard of a “high-functioning alcoholic”? In fact, you may know someone in your circle who is labeled as such. While not a medical diagnosis, it is a colloquial label given to someone who is able to carry out different tasks required in their daily, personal, and professional life without struggling with the wide range of impairments typically associated with alcohol use disorder.
While alcoholism is not always easy to identify, in this article, we aim to raise awareness regarding a high-functioning or functioning alcoholic and how they can benefit from recovery as well.
What Exactly Is A High-Functioning Alcoholic?
When you picture alcoholism, you might often picture someone who is not able to control their drinking and is struggling with a myriad of things in their personal and professional lives, along with other health struggles. However, alcoholism or alcohol use disorder (AUD) exists on a continuum. With high-functioning or functioning alcoholics, alcoholism does not meet the eye as it does in other cases. The main reason for this is functional tolerance, which allows the brain functions to adapt and compensate for the disturbances that alcoholism leads to in behavior and bodily functions.
High-functioning alcoholics can consume greater quantities of alcohol than is recommended (2 drinks per day for males and 1 drink per day for females), but they can abstain from drinking during the entire week or binge drinking episodes. Moreover, the fact that they are able to cover their drinking by carrying out their daily activities further complicates the diagnosis.
An estimated 20% (some studies even suggest 50% – 70%) of those who meet the criteria for AUD can seem like high-functioning alcoholics. This does not mean that alcoholism is not a risk. It most definitely is. Therefore, you need to be aware of the signs of a high-functioning alcoholic to get yourself or a loved one the care they need and deserve.
What Are The Signs Of A Functioning Alcoholic?
Functioning or high-functioning alcoholics rarely show the external signs of alcoholism, but their health and well-being are still at risk. It is easy to overlook the damage that alcoholism is doing on the inside when the outside seems well put together. But when you are able to recognize the signs and symptoms of high-functioning alcoholics, you can get them the care they need before the condition worsens.
Here are the signs and symptoms of a high-functioning alcoholic you need to keep an eye out for:
- Heavy (even excessive) drinking.
- Strong cravings to use alcohol.
- Concealing their drinking behaviors by drinking in secrecy.
- Denial of their problematic drinking patterns.
- Show a high tolerance for alcohol, which means that they can consume large quantities of alcohol without appearing to be intoxicated.
- Known for being able to perform well in life despite heavy drinking.
- Changes in personality when they consume alcohol – they can become more sociable or even aggressive.
- Drinking to cope – deal with stressors, anxiety, or other trauma.
- Experience blackouts, wherein they struggle to remember the episodes of heavy drinking.
- Feel guilty or ashamed of becoming intoxicated or displaying the negative behaviors they displayed under the influence of alcohol.
- Become irritable when they are unable to drink everyday; so, they obsess over acquiring the next drink while also obsessing over how to control how much they drink.
- Experience alcohol withdrawal symptoms when they reduce or stop alcohol intake.
What Are The Risk Factors For High-Functioning Alcoholics?
The risk factors for high-functioning alcoholics are not much different from what they are for other kinds of alcoholism. They look something like this:
- Often exceeding the limits of 14 (for males) or 8 (for females) drinks per week.
- Genetics can play a role in alcoholism; if a close relative struggles with alcoholism, there is a greater chance that one might also develop AUD in life.
- Alcoholism often co-occurs with other mental health conditions, wherein each feeds off and worsens the other. For instance, alcoholism can co-occur with high prevalence in other mental health conditions like anxiety, depression, bipolar disorder, borderline personality disorder, antisocial personality disorder, and schizophrenia, among others.
- Ongoing stressors in life – in school, college, or a job.
The Dangers of Alcoholism
High-functioning alcoholics may not exhibit the general signs associated with alcoholism; they may not show physical signs of alcoholism or let their drinking patterns disturb their personal, social, and professional lives. These high tolerance levels for alcoholism, however, do not exempt them from the common dangers of alcoholism. Here are some of the risks that even high-functioning alcoholics can face:
- Engaging in high-risk behaviors while under the influence of alcohol
- Injuries or accidents while under the influence of alcohol
- Alcohol poisoning
- Increased dependence on alcohol
- Liver and cardiovascular conditions
- Cognitive dysfunctions with learning and memory
- Mental health conditions
- Premature death.
Why Is Functional Tolerance A Red Flag?
In a culture that celebrates and glorifies drinking, being able to “hold your drink” is often a brag. But the functional tolerance for alcohol, where one can consume exceedingly large quantities of alcohol without becoming intoxicated, is a danger. It allows one to go about their lives as if nothing were wrong, but the damage that alcohol is doing to their brain and body can become life-threatening. In fact, it can become more of a threat when alcoholism goes undiagnosed and something drastic happens suddenly. This is often the case with high-functioning alcoholics.
Therefore, never ignore the signs of a high-functioning alcoholic within yourself or a loved one. You and others can benefit from inpatient rehab, outpatient rehab, sober living, and peer support options, even if you are struggling with high-functioning alcoholism.
Are You At Risk?
If you believe you are showing the signs of a high-functioning alcoholic, then the best way to know this is to reach out to licensed and trained mental health practitioners who can confirm the diagnosis.
Basically, when you are drinking more than the recommended units of 14 or 8 (male and female) drinks per week, you can approach healthcare providers who will use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) and other screening tools like the Alcohol Use Disorders Identification Test (AUDIT) to understand whether you can benefit from treatment.
What Do The Treatment Options For High-Functioning Alcoholism Look Like?
Depending on how severe alcoholism is, high-functioning alcoholism can be treated in both inpatient and outpatient settings. Typically, the recovery options for the condition look something like this:
Medically Supervised Detoxification (Detox) – During detox, alcohol levels are gradually tapered off from the body so as to minimize and manage cravings and withdrawal symptoms.
Psychotherapy – Therapy is provided in both one-on-one and group settings so that a person benefits both from privacy and shared learning environments. Typically, motivational interviewing, cognitive behavioral therapy, contingency management, and 12-step recovery models are used.
Medication Management – Medication can be prescribed whenever the need arises to reduce cravings and other alcohol-related symptoms to prevent relapse and raise the quality of life.
Ongoing Care – As recovery is not a final destination but a journey, ongoing care involving therapy, counseling, personalized relapse prevention, sober living options, and peer empowerment programs like Alcoholics Anonymous are recommended to establish and maintain sobriety.
It Is Not Just A Phase
Social drinking can quickly spiral into alcohol use disorder, and while many do not show the outward signs of alcoholism, they are still at risk of a myriad of physical and mental health conditions. Therefore, alcoholism is never “just a phase.” It is often challenging to limit yourself to just one drink, so abstinence is generally recommended.
However, abstinence in itself can be challenging to achieve on your own. So, if you are struggling with high-functioning alcoholism, it is never too early to seek care. At Skyline Recovery, we provide partial hospitalization programs, intensive outpatient programs, and standard outpatient treatment for the different levels of alcoholism.
Do not delay any longer. Please reach out to us today, and we can take this journey toward sobriety together.
References –
https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
https://psycnet.apa.org/record/2009-13431-000
https://www.bloomsbury.com/in/understanding-why-addicts-are-not-all-alike-9780313387081/
https://pubs.niaaa.nih.gov/publications/aa28.htm
https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787