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Nearly 15 million Americans aged 12 and older—9 million men and 5.5 million women—suffer from alcohol use disorder (AUD). 1 But the total number of people with an addiction to alcohol, and all the problems that come with this, is likely much higher. So-called “functioning alcoholics” are often in deep denial: unaware or ignoring that there’s a problem in their relationship with alcohol.
The term “alcoholism” or the formal diagnosis “alcohol use disorder” may conjure an image of someone unable to clean, dress, and feed themselves—much less hold down a job and maintain healthy relationships. But having an alcohol use disorder doesn’t necessarily mean a person cannot function in their daily life.
People known as high-functioning alcoholics go to work, manage their bank account, meet family responsibilities, and drive without getting a DUI. But they also experience the alcohol cravings and withdrawal symptoms that are primary components of alcohol use disorder.
Just because someone with an alcohol use disorder is “functioning” at a basic level (e.g., going to work every day and staying out of jail) doesn’t mean they’re functioning at an optimal level in every aspect of their lives. The difference between “just getting by” and maximizing one’s potential as a human being is significant. Functional or not, alcohol use disorder is a serious mental illness with various damaging consequences.
For people who are struggling with alcohol use disorder and seeking a luxury treatment center, this page provides vital information about functioning alcoholism—including a high-functioning alcoholism quiz and an overview of treatment options.
The terms alcoholism, alcohol dependency, alcohol abuse, alcohol addiction, and alcohol use disorder 2 are often used interchangeably. However, team members at AToN Center never refer to their residents as alcoholics. Instead, they are understood to be people who have alcohol use disorder. Stigmatizing language is avoided, so residents feel safe, supported, and respected throughout their healing journey.
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High-Functioning Alcoholism Self-Test
What is High Functioning Alcoholism?
High-functioning alcoholism is also known as functional alcoholism or working alcoholism.
A high-functioning alcoholic [3] is a person who appears to have their drinking habits under control. While they may drink a lot—too much and too often—they seem (by most external measures) to be “holding it together” in the various aspects of their life: work, family, finances, and so on.
Essentially, a high-functioning alcoholic is an individual who is, indeed, addicted to alcohol—i.e., they meet the diagnostic criteria for alcohol use disorder. But they haven’t yet experienced the full force of potential negative consequences of their drinking habit. For this reason, their alcohol use disorder doesn’t dramatically interfere with their capacity to meet daily responsibilities.
Working alcoholics can still hold down a job or build a career—and potentially excel in their work. For the time being, they’ve avoided the major legal, social, and health-related effects of their drinking. Eventually, though, excessive drinking catches up with people—even those who, for many months, years, or decades appeared entirely “functional.”
Functional Alcoholism & Societal Notions of Success
There’s often a stigma attached to addiction: a belief that those with substance use disorders (including AUD) must be homeless, unemployed, uneducated, and from a lower economic status. But such beliefs are simply not true.
Addiction affects people from all walks of life. When it comes to alcohol use disorder, the only things that truly matter are the patterns of use and relationship to drinking—and not the person’s demographic characteristics.
However, when a person exhibits certain social standards of success, others may assume that the person is “functioning” well and couldn’t possibly have an alcohol use disorder. Such social markers of success include:
- Being college-educated
- Having a promising job/career
- Owning a nice house
- Being in a steady relationship
- Having a happy family
- Engaging in hobbies or other creative outlets
- Holding a public office
However, in the case of a functioning alcoholic, this all may be an illusion. Beneath the façade of a socially acceptable lifestyle, the person with AUD could be experiencing alcohol cravings and withdrawal symptoms along with the stress of continually denying (to themselves and others) that there’s a problem.
The appearance of “functionality” may be carefully fabricated to keep their alcohol use disorder hidden and unchecked. In such cases, it can become challenging to determine the person’s true relationship to alcohol.
For instance, an alcoholic who is high functioning may never get fired for coming to work while intoxicated. They may never be arrested for driving under the influence or have arguments with their spouse or partner about their alcohol use. They may also be able to maintain relatively good physical health for years or decades before the inevitable effects of long-term alcohol abuse catch up with them.
However, the ability to drink a lot and still meet one’s responsibilities doesn’t mean a person is free from the symptoms and effects of alcohol use disorder. AUD drinking patterns and consequences are no different for a functional alcoholic than for anyone with an alcohol use disorder. What separates the two are simply societal notions of success, as mentioned above.
The bottom line is that a high-functioning alcoholic’s addiction is just as dangerous as someone who has multiple DUIs, gets into bar fights, or has arguments with their spouse about their drinking habit. It may be even more dangerous if it remains hidden and untreated.
Signs of High-Functioning Alcohol Use Disorder
Mental health professionals’ criteria for diagnosing alcohol use disorder (AUD) are described in the Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5). There are 11 specific symptoms that a psychiatrist or counselor will look for. The number of symptoms a particular individual exhibits will determine whether the alcohol use disorder is mild, moderate, or severe.
The specific combination of symptoms and their physical, mental, and emotional effects—can differ widely from one person to the next. And this is true for all types of AUD, including the functional variety.
A functional alcoholic, however, may be especially tricky to recognize and diagnose because of their heightened tendency to be dishonest and secretive about their drinking habits.
High levels of denial characterize functional alcoholism. Such a person is more likely to deny that they need help and so less likely to seek out and accept help. Often, only the people closest to them will realize that the high-functioning alcoholic has an alcohol use disorder.
Warning Signs & Symptoms of Alcohol Use Disorder
As with AUD in general, no single factor can determine conclusively whether a person is a high-functioning alcoholic. And it’s important to remember that someone “functioning” with their alcohol addiction still has an alcohol use disorder.
The following warning signs and symptoms of alcohol use disorder are common in all forms of AUD, including the functional variety:
- Drinking excessive amounts of alcohol. Functioning alcoholics will consume far more alcohol than the national average or recommended amounts. 4
- Experiencing constant cravings for alcohol throughout the day.
- Increased tolerance—needing increased amounts of alcohol to achieve the same level of intoxication.
- Feeling nervous or fearful about not being able to consume alcohol or worried about where their next drink will come from.
- Drinking alone at home—sometimes even in the morning before work.
- Keeping one's drinking a secret.
- Alcohol use causing strained relationships.
- Social or recreational activities—the individual used to enjoy—are reduced or given up in favor of indulging in their alcohol habit.
- Losing control—or acting in ways they later feel embarrassed about—while under the influence of alcohol.
- Becoming frustrated or upset when something interferes with their drinking plans.
- Repeatedly making commitments to quit or moderate alcohol intake—which they don't keep.
Signs & Symptoms of Functional Alcoholism
The following warning signs and symptoms are characteristic, in particular, of the functional variety of AUD:
- Drinking throughout the day but never getting so drunk that they cannot perform their regular work or family duties. Moderate drinking throughout the day indicates that the individual is attempting to reduce cravings and prevent withdrawal symptoms.
- Abstaining from drinking throughout the week but then binge drinking on the weekends. Or abstaining from drinking during work hours, but then binging at night after their work is done.
- Consistently denying that they have a drinking problem—even though the individual drinks excessively. Functioning alcoholics are in denial. They don't see themselves as having an alcohol use disorder because they have a job, family, hobbies, and a circle of friends.
- Getting defensive about their use of alcohol—insisting that there's nothing wrong.
- The mood and temperament of the individual tends to affect everyone else in their work or home environment. Through both subtle and explicit cues, a functional alcoholic tends to dictate the terms for how other people engage and behave around them.
- The mood and temperament of the individual tends to affect everyone else in their work or home environment. Through both subtle and explicit cues, a functional alcoholic tends to dictate the terms for how other people engage and behave around them.
- The individual's children have stopped bringing friends over to the house. And their family members are constantly on edge.
- Having a dedicated time for drinking, each day or week—and defending it as a ritual that just "helps them relax and unwind after a busy day."
- Experiencing health problems due to their drinking. People who drink heavily for many years—no matter how apparently "functional" the drinking may be—increase their risk of developing certain cancers and liver disease. Long-term alcohol abuse can also result in a dangerous vitamin deficiency called wet brain, which causes permanent memory loss and brain damage.
Statistics for High-Functioning Alcoholism
Scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have discovered five distinct subtypes 5 of alcohol use disorder—one of which is the functional variety.
This research revealed that the characteristics of functional alcohol dependency include:
- Functional alcoholics comprise approximately 19.5% of the U.S. population of people with alcohol use disorder.
- People with high-functioning alcoholism tend to drink every other day and consume five or more drinks per sitting.
- Around 60% of those in the functional subtype are male.
- People in the functional subtype are the most likely of all the alcohol addiction subtypes to be college-educated; and the least likely to use illegal drugs.
- Most are middle-aged (around 41), work full-time, and have stable relationships and high earnings.
- About one-third of people in the functional subtype of AUD have a multigenerational family history of alcoholism.
- Around 50% of the functional subtype are married.
- The functional subtype suffers from moderate rates of depression but lower rates of most other co-occurring mental disorders. About 25% have had major depressive illness sometime in their lives.
- They have the highest education levels and incomes of all AUD subtypes.
- Many members of this group (about 50%) smoke cigarettes, but few have other substance use disorders.
- Members of the functional subtype generally start drinking at a later age (around 18) and develop alcohol dependence later (around 37) than those in other subtypes.
- The functional subtype of AUD is the least likely to have legal problems and the least likely to report issues due to their drinking.
- Less than 20% of the functional subtype has sought help. When they do seek help, most do so from a 12-Step program or a private healthcare professional.
Treatment Options for High-Functioning Alcoholism
While strong denial is a component of functional alcoholism, many people suffering from this subtype of AUD eventually realize that they need help from an addiction treatment program. When confronted with how much they are drinking and how their drinking habits are negatively impacting various aspects of their lives, they wisely seek treatment.
What are the best treatment options for high-functioning alcoholism? Like any form of AUD, detox and rehab at an alcohol treatment center is the recommended protocol to support full recovery from alcohol addiction.
After the initial intake and assessment, the first step toward recovery is to enter a supervised detox process to ensure that all alcohol is removed from the body. In some cases, the detox will be medically assisted—to safely manage potentially dangerous withdrawal symptoms.
Once the detox is complete, the central component of rehab for high-functioning alcoholics is individual and group therapy facilitated by mental health professionals. The focus of treatment is understanding the root cause of the addiction; developing healthy self-care routines; and learning how to relax and have fun in ways that don’t involve alcohol.
Cognitive Behavioral Therapy for AUD Treatment
Among the various psychotherapeutic modalities, cognitive behavioral therapy (CBT) has proven to be particularly effective in supporting recovery from AUD. 6
CBT helps the person recovering from alcohol addiction learn to identify and modify thought processes and behaviors that are not conducive to health and happiness. Often, unhealthy thought processes trigger or contribute to addictive behaviors.
Cognitive behavioral therapy aims to help the person unwind from maladaptive behaviors and learn or relearn more effective coping skills. After learning such new skills, the person can apply them in situations that typically trigger alcohol use. By applying the new skill, the addictive behavior is averted.
Modified forms of cognitive behavioral therapy—which are also used in the treatment of AUD—include:
- Diaectical behavioral therapy (DBT) 7
- Acceptance and commitment therapy (ACT)
- Mindfulness-based cognitive therapy (MBCT) 8
- Rational emotive behavior therapy (REBT)
The group therapy component of treatment for functional alcohol addiction often includes participation in an Alcoholics Anonymous 12-step program—for valuable peer support.
Find Luxury Treatment at the AToN Center
For those seeking a luxury treatment center to support recovery from alcohol use disorder, the AToN Center in southern California is an excellent option.
AToN Center offers medically assisted detox and rehab programs featuring individual therapy sessions, 12-Step programs, and 12-Step alternatives.
AToN Center is located on a beautiful private ten-acre sanctuary surrounded by trees and waterfalls. A team of caring staff, skilled counselors, and medical professionals expertly support each resident’s path to recovery.
The luxury lifestyle amenities that residents have access to include:
Residents can choose among therapies to nourish and heal the body, mind, and soul, including massage, acupuncture, hypnotherapy, yoga, physical therapy, and personal training. Unlimited group holistic activities include sound bowl healing, breathwork, meditation, hiking, boot camp, yoga, and painting class.
Skilled chefs prepare healthy and delicious meals daily and accommodate the specific dietary needs of each resident.
Every home has a jacuzzi and pool, along with lush gardens. Residents can enjoy the beautiful grounds and create a community with their housemates. And each resident’s room is a space where they can have privacy, relaxation, comfort, and quiet.
The team at AToN believes there is no one-size-fits-all approach to recovery. They believe in collaborating with residents to achieve a recovery philosophy and approach that works best in their life and honoring each resident’s unique path to full recovery.
- Alcohol Facts and Statistics: Alcohol Use in the United States. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
- Understanding Alcohol Use Disorder. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
- High Functioning Alcoholic: What To Know. Medical News Today. https://www.medicalnewstoday.com/articles/high-functioning-alcoholic
- Dietary Guidelines for Alcohol. Centers for Disease Control and Prevention. https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm#:~:text=To%20reduce%20the%20risk%20of,days%20when%20alcohol%20is%20consumed
- Researchers Identify Alcoholism Subtypes. National Institutes of Health. https://www.nih.gov/news-events/news-releases/researchers-identify-alcoholism-subtypes
- What Is Cognitive Behavioral Therapy? American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
- Dimeff LA, Linehan MM. Dialectical behavior therapy for substance abusers. Addict Sci Clin Pract. 2008 Jun;4(2):39-47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797106/
- What Is Mindfulness-Based Cognitive Therapy? Brown University School of Public Health. https://www.brown.edu/public-health/mindfulness/ideas/what-mindfulness-based-cognitive-therapy
Clinically reviewed for accuracy by: Karen Yazzie-Meyer, CADCII