High Functioning Alcoholics

What Is a High-Functioning Alcoholic?

According to a recent National Institute on Alcohol Abuse and Alcoholism survey, nearly 15 million Americans age 12 and older have alcohol use disorder (AUD).

High-functioning alcoholism is not a medical diagnosis.

“High-functioning alcoholic” is a term used to describe someone suffering from alcohol dependency or addiction but still able to function relatively normally.

A high-functioning alcoholic can go about daily life and take care of their obligations (like work or school) primarily undetected.

These individuals may regularly participate in heavy drinking or similar behavior but manage to maintain their responsibilities without friends or loved ones realizing how problematic their drinking habits have become.

To the outside world, someone who is a high-functioning alcoholic often does not show many signs and symptoms of AUD. They will often appear both physically and mentally healthy.

Below the surface, they face many of the same struggles of having an AUD, including cravings and unsuccessful attempts at quitting.

Difference Between High Functioning Alcoholism and AUD

High-functioning alcoholism is a term to describe someone suffering from an alcohol use disorder who manages to maintain a certain appearance, making it seem like they have control over the amount of alcohol they regularly consume.

However, these individuals still have to deal with the effects of alcohol abuse, including mental and physical health problems.

Medical professionals now use alcohol use disorder (AUD) as an umbrella term to describe all alcohol-related issues, including high-functioning alcoholism.

According to the DSM-5, to have an alcohol use disorder, you must have at least two of the following characteristics:

• Try to cut back or stop drinking but can’t
• Continue to drink even though you know you shouldn’t
• Spend a significant amount of time either drinking or thinking about drinking
• Get cravings to drink
• Engage in dangerous activities as a result of drinking
• Experience withdrawal symptoms when not drinking
• Needing increasing amounts of alcohol to reach your desired effect
• Continuing to drink despite it causing problems

What Are the Signs of High Functioning Alcoholism?

High-functioning alcoholics don’t tend to show signs of an AUD on the surface, making it difficult for loved ones to see that they have a problem and offer help.

Here are some common warning signs of someone dealing with high-functioning alcoholism

• Drinking more than two alcoholic drinks per day
• Losing control while drinking
• Trying to cut back or quit unsuccessfully
• Hiding your drinking from others
• Lying about your drinking
• Getting into arguments or fights with friends or family members over your drinking
• Getting into financial or legal trouble as a result of drinking (i.e., getting a DUI)
• Developing physical or mental health issues due to drinking, even if they are not noticeable to others
• Drinking a lot without appearing intoxicated
• Drinking during inappropriate times
• Finishing other people’s drinks
• Making jokes about having a drinking problem

High Functioning vs Non-High Functioning Alcoholics

While someone who is a high-functioning alcoholic might be good at hiding their AUD to the point where people around them don’t know, non-high-functioning alcoholics tend to show more of the traditional signs associated with an alcohol use disorder.

Someone who is a non-high-functioning alcoholic may be more likely to:

• Show physical and mental signs of alcohol addiction
• Drink in a way that prevents them from being able to complete daily tasks
• Become isolated from others
• Have noticeable changes in their physical appearance
• Exhibit risky behaviors while drinking
• Has more severe withdrawal symptoms when not drinking

Causes and Risk Factors of High-Functioning Alcoholism

According to the National Institutes of Health (NIH), the typical high-functioning alcoholic is a middle-aged, well-educated person with a stable job and a family.

While there is no known cause of any type of alcohol use disorder, including high-functioning alcoholism, some mitigating factors can play a role in developing an alcohol-related issue.

Some alcoholism risk factors include:

• Binge drinking (having five or more drinks in a day)
• Exposure to peer pressure to drink, especially at a young age
• Having a family member who suffers from an AUD
• Struggling with mental health issues
• Having low self-esteem
• Having more than seven drinks in a week for women or 14 drinks for men

The NIH has also found that nearly half of all high-functioning alcoholics are smokers.

Negative Consequences of Alcoholism

Even if you don’t struggle with AUD, drinking alcohol has physical and mental health risks. The more you drink, the greater your chances of developing a physical or mental health problem.

Physical and mental health issues that can arise as a result of excessive drinking include:

• Alcohol poisoning
• Weakened immune system
• High blood pressure
• Irregular heartbeat
• Developing mental health conditions such as depression and anxiety
• Short-term memory loss (blackouts)
• Long-term memory loss
• Fatty liver disease
• Fibrosis
• Cirrhosis
• Pancreatitis
• Certain cancers
• Cardiomyopathy

In addition, heavy drinking comes with the risk of financial, legal, and family problems.

Treatment for High Functioning Alcoholism

All types of alcohol use disorder, including high-functioning alcoholism, are treatable. Individuals receive treatment through medications, therapy, support groups, or a combination of the three.

Additionally, individuals can opt into alcohol rehab programs that offer varying levels of care depending on the person’s unique needs.

Treatment Programs

In some cases, high-functioning alcoholics will experience alcohol withdrawals once they quit drinking. However, alcohol withdrawal is potentially life-threatening, so your doctor or healthcare provider may recommend starting with a medical detox program.

Medical detox means that you will go through the withdrawal process under medical supervision, but it doesn’t necessarily require you to check in at a treatment facility.

In fact, many individuals experience medical detox at an outpatient level, while individuals with more serious addictions may opt for an inpatient medical detox situation.

After completing detox, you may participate in an alcohol treatment program at a substance abuse treatment center. Like medical detox, inpatient and outpatient options are available based on your specific needs.

Medications

Medication-assisted treatment is a proven technique for treating alcohol withdrawals.

Certain FDA-approved medications can be prescribed to help reduce cravings, discourage relapse, and ease some of the symptoms associated with withdrawal.

Medications that are effective in treating AUD include:

• Naltrexone (Vivitrol®)
• Disulfiram (Antabuse®)
• Acamprosate (Campral®)
• Gabapentin

Therapy

Psychotherapy, or “talk therapy,” is a popular counseling method for treating alcohol addiction. Both individual and group therapy sessions are offered at most alcohol treatment programs, both at the inpatient and outpatient levels.

For instance, cognitive behavioral therapy (CBT) helps people address the mental component of addiction. CBT helps patients peel back the metaphorical layers, allowing them to understand the factors that contributed to their alcohol use disorder.

Through CBT, those in recovery can also learn healthier ways to deal with possible triggers and cravings moving forward.

Support Groups

Support groups can help those in recovery by providing them with a much-needed support system. Support group meetings are not just a vital part of the treatment process but are regularly used even after completing formal treatment.

Alcoholics Anonymous (AA) and SMART Recovery are support groups specifically designed for people in recovery from an alcohol-related condition.

Get Help for High-Functioning Alcoholism

While being a high-functioning alcoholic might not seem like a big issue because it doesn’t yet impact your daily life, when left untreated, it can eventually catch up with you.

Call the SAMHSA helpline at 1-800-662-4357 or visit their online program locator to find alcohol addiction treatment options in your area. 

Written by

Jessica Miller

Editorial Director

Jessica Miller is the Editorial Director of Addiction Help. Jessica graduated from the University of South Florida (USF) with an English degree and combines her writing expertise and passion for helping others to deliver reliable information to those impacted by addiction. Informed by her personal journey to recovery and support of loved ones in sobriety, Jessica's empathetic and authentic approach resonates deeply with the Addiction Help community.

Reviewed by

• Fact-Checked
• Editor

Kent S. Hoffman, D.O.

Co-Founder & Chief Medical Officer

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is the Co-Founder and Chief Medical Officer of AddictionHelp.com and ensures the website’s medical content and messaging quality.