What Is a High-Functioning Alcoholic? Signs, Risks, and How to Help

We all have preconceived notions of what an alcoholic looks like. But not everyone abusing alcohol fits into the stereotype we imagine. Many high-functioning alcoholics have very successful careers, raise families, and generally seem to be doing everything right, all the while secretly dealing with a serious drinking issue.

This is often described as being a “high-functioning alcoholic.”

In this article, we’ll explain exactly what this term really means, outline the signs to watch for, and provide guidance to loved ones who want to help.

What is a Functioning Alcoholic?

A functioning alcoholic, or high-functioning alcoholic, is a common but informal term, not a clinical diagnosis. It is used to describe a certain pattern of drinking that meets the criteria for an alcohol use disorder (AUD), while the person appears to be functioning normally.

However, despite appearances, the diagnosable condition for this person is still alcohol use disorder, which is a medical term that describes a problematic relationship with alcohol that causes significant impairment or distress.[1] AUD is diagnosed on a spectrum from mild to severe, based on certain criteria, and not on how “normal” someone appears or how well they are able to maintain their personal and professional lives.[2]

The term “high-functioning” is only used to describe someone who is still able to meet daily obligations, such as work, maintaining relationships, paying bills, and others, all while drinking in ways that meet the criteria for an alcohol use disorder. This can often create a false sense of security for the person, their loved ones, and those around them, since the warning signs, while still there, are much less obvious.

Signs of a High-Functioning Alcoholic

Since high-functioning alcoholics are so different from the stereotypical images of people struggling with alcoholism, loved ones often have no idea whether a friend or family member has a potentially serious drinking problem.

Below are some common warning signs to watch for in a loved one or yourself:

• Drinking heavily, but rarely seeming visibly intoxicated
• Needing an increasing amount of alcohol to produce the same level of effect as previously experienced. This is a sign that tolerance is building
• Making excuses to drink, or minimizing the number of drinks being consumed
• Drinking alone, or starting to drink earlier in the day than other people
• Experiencing blackouts, which are gaps in memory for events that took place while intoxicated
• Feeling irritable or restless, or unable to relax, when not drinking.
• Continuing to drink despite early health problems or concern from relatives or friends about their drinking habits.
• Using alcohol as a way to cope with emotional difficulties, such as stress or anxiety.

Each of these characteristics individually doesn’t mean that someone has alcohol use disorder. However, when you or someone you love exhibit many of these traits on a recurring basis, it’s likely indicative of an ongoing issue that should be taken seriously.

Why Outward Appearances Can Be Misleading

The common misconception is that everyone struggling with alcoholism will show signs of significant decline and a life of disarray, whether at home, work, or in social settings, along with appearing visibly intoxicated much of the time. However, many people with alcohol use disorder (AUD) lead productive careers for years and, in some cases, use their success as a form of proof, to themselves and to others, that they don’t have a problem.

This disconnect between the outward appearances and the actual internal deterioration is part of why their AUD remains undiagnosed and unaddressed for so long. Members of the person’s immediate family may sense that something is wrong but can’t provide concrete evidence to substantiate their feelings. Similarly, the person involved may also view their continued success as justification for not addressing their issue.

Health Risks of Long-Term Heavy Drinking

Regardless of how well someone seems to be functioning and how successful they are in their careers, prolonged heavy drinking creates the same physical health consequences as it does for anyone else.[3]

Some possible physical health consequences include:

• Liver damage, including fatty liver disease and cirrhosis
• Heart disease and high blood pressure
• Increased cancer risk
• Weakened immune system
• Mental health issues, including worsening anxiety, depression, or mood swings
• Increased risk of accidents or injury due to impaired judgment, even if they don’t seem visibly intoxicated or otherwise impaired

These potential health-related consequences develop slowly and silently, which is why “high-functioning” can be misleading. No matter if someone appears to have their life under control or not, their body responds the same way to long-term excessive consumption of alcohol.

Why Is It Crucial for High-Functioning Alcoholics to Seek Help?

Because high-functioning alcohol use disorder typically doesn’t create the acute crises that would otherwise prompt someone to pursue treatment, it’s not uncommon for this type of AUD to remain untreated for several years. Over time, this allows for the development of additional chronic health issues related to excessive drinking, and increases the severity of psychological dependence on alcohol. There is no need to wait until a dramatic loss-of-control, rock-bottom event like losing a job, destroying a relationship, or discovering a serious medical concern before getting help.

In fact, seeking professional treatment sooner, before a crisis forces the issue, provides better opportunities for recovery. Because alcohol use disorder is a progressive illness, early treatment can be less intensive compared to treatment sought later, after years of escalating use.

How Can Friends and Family Help?

Helping a friend or family member struggling with alcohol use disorder despite outward appearances presents unique challenges. It’s essential to find a delicate balance between honesty and compassion when trying to encourage a loved one to get professional help.

Below are some approaches to try:

• Expressing specific concerns based on observable behavioral patterns, rather than vague generalizations about their behavior.
• Avoiding enabling behaviors, such as making excuses for their drinking or helping them cover up poor decisions made while intoxicated.
• Encouraging professional evaluation, since they can receive an unbiased assessment from a healthcare provider or addiction specialist.
• Being patient. Someone with a successful career may resist admitting a drinking problem longer than anticipated.
• Finding your own support, through family therapy or support groups specifically established for family members impacted by a loved one’s substance use, regardless of whether the person chooses to accept treatment.

Treatment Options for Alcohol Use Disorder

Treatment for alcohol use disorder begins with a professional assessment of the extent of the problem, so the proper level of care can be determined, including a medical detox program if necessary, or either inpatient or outpatient treatment, based on severity of addiction and their daily responsibilities.

Evidence-based practices like behavioral therapies, support groups like Alcoholics Anonymous, and, for those who need it, medication-assisted treatment for craving and withdrawal symptom management are all effective components of alcohol addiction treatment. Developing an aftercare plan to provide ongoing support after treatment is also vital, because continued support raises a person’s chances of achieving long-term sobriety and reduces the risk of relapse.[4]