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What’s a High-Functioning Alcoholic? Know the Signs and Get Help

What is a High-Functioning Alcoholic?

You are successful at work, have good relationships with your family and friends, and as far as appearances go, you’re doing fine. Yet appearances can be deceiving. Despite your apparent success, your alcohol consumption is far higher than it should be.

Heavy drinking for women is defined as having more than three drinks a day, or seven a week, according to the U.S. Centers for Disease Control and Prevention (CDC). For men, heavy drinking is four or more drinks per day, or 14 per week. Men and women who drink more than that, but have yet to experience the outward signs of alcoholism, may be “high-functioning alcoholics,” or “functional alcoholics.”

Functional alcoholics don’t fit the stereotype of an alcoholic as someone whose physical health, job and relationships have been wrecked by excessive drinking.
Functional alcoholics often appear to be unaffected by their excessive drinking.

Active alcoholics love hearing about the worse cases, we cling to stories about them…the bum in the subway drinking from the bottle: the red-faced salesman slugging it down in a cheap hotel. Those alcoholics are a good ten or twenty steps farther down the line than we are, and no matter how many private pangs of worry we harbor about our own drinking, they always serve to remind us that we’re OK, safe, in sufficient control.” – Caroline Knapp, in “Drinking: A Love Story,” her memoir about alcoholism.

Functioning Alcoholism Afflicts Professionals

Physicians, attorneys, business leaders and others in professional roles often fall into the category of high-functioning alcoholics. Their financial resources, social support and internal drive allow them to continue to achieve or perform their job, despite heavy drinking. Functional alcoholics often do a good job of keeping the quantity and frequency of their alcohol consumption hidden – at least for a period of time.

Even though they may appear to be unaffected by their drinking, the damage is still occurring. Drinking too much for too many years causes mental function and memory to suffer. Physical health starts to decline. Excessive alcohol consumption can contribute to heart disease, liver damage, gastrointestinal disorders, sexual dysfunction, and some kinds of cancer.

And while initially their work and home life doesn’t seem to suffer, this too often changes for the worse. Family members and friends get tired of having to manage the behavior of someone who gets too drunk at social events or is too hungover to fulfill family or work responsibilities. Spouses get to the point where they’ve had enough of the mood swings and irresponsible behavior that goes along with chronic inebriation, and relationship problems occur.

Men and women who are functional alcoholics may also eventually progress to chronic alcoholism or severe alcoholism. When the alcohol use disorder has gotten bad enough, the signs of alcoholism become impossible to hide.

Signs of Functional Alcoholism

Functional alcoholics are often deeply in denial about their drinking being a problem. Some functioning alcoholics don’t recognize that drinking so much is hurting them and those around them. They may compare their own lives to the stereotype of a chronic or severe alcoholic who is destitute. Functional alcoholics are skilled at pointing to external factors, like their career or social stature to argue that they don’t have a drinking problem.

In addition to heavy drinking, here are some signs of high-functioning alcoholism.

  • Setting rules about drinking, such as only drinking light beer or only drinking after 5 pm and using this to justify consuming far too much alcohol. Adhering to these rules helps create a façade that they don’t have a problem.
  • Ability to control drinking for a period of time, then possibly binging when returning to drinking.
  • Blacking out due to drinking or forgetting what you did.
  • Needing friends or family to make excuses for missed appointments, failure to show up at work or important social gatherings because of being drunk or hungover.
  • Isolating in order to drink. Begging off social events to stay home and drink. Drinking alone, at home or at bars.
  • Having another mental health problem such as depression, anxiety disorder, bipolar disorder, social phobia or an eating disorder. Some people drink as a way to “self-medicate” psychological pain, emotional distress or symptoms of mental illness.
  • Needing to have others post bail and pay legal fees or other fines incurred when the individual was under the influence.
  • Showing anger when questioned about alcohol consumption.
  • Losing friends or relationships due to drinking or behavior while drinking.

Getting Treatment for Alcoholism Before It’s Too Late

High-functioning alcoholics may continue to be able to earn a living, support a family or manage a household. Yet the family members of functional alcoholics, including spouses and children, suffer significant psychological damage. Spouses and children may feel anxious or frightened by their loved one’s behavior while drinking. Family members may need to lie for their loved one, or cover for the alcohol use disorder so it doesn’t cause job loss or embarrassment to the individual or family. Over the course of months and years, this takes a significant emotional toll.

Family members also may inadvertently enable the alcoholic’s behavior by helping them avoid the negative consequences of excessive drinking. Because functional alcoholics often have high-status careers, a respected place in their community and may be responsible for the family income, the pressure on spouses, business partners and others in the alcoholic’s orbit to minimize the fallout of their drinking can be intense. Especially for spouses, the need to minimize the external damage done by the alcoholic spouse can lead them to neglect taking care of their own health and emotional needs.

Often, functional alcoholics only face their drinking problem when they’ve gotten a DUI, multiple DUIs, or worse–have injured themselves or others in a car wreck. Legal costs, jail time and the loss of a driver’s license can strip away the veneer of being in control of their alcoholism.

How to Approach a High-Functioning Alcoholic

Confronting an individual about getting treatment for their drinking problem is never easy, and an individual’s apparent success may make it more difficult. Like others with substance abuse disorders, high-functioning alcoholics may lash out angrily at being accused of drinking too much or not being in control of their alcohol consumption.

When you approach someone about their alcohol use disorder, be prepared for excuses and denials. They may deflect, or try to make the conversation about you and not about them. They may try to convince you that they don’t have a problem.

If possible, speak to your loved one when they’re not drinking, or after they’ve promised to cut back. They may be more receptive to hearing your concerns.

Let them know that you care and that you’re sharing your concerns because of how much you value their love, their friendship or their role in the family.

Research alcohol treatment centers and mutual aid groups such as Alcoholics Anonymous. Present them with some options for getting help from addiction treatment professionals. Treatment for alcoholism should also encompass treatment for dual disorders such as depression and anxiety that may contribute to their drinking. By getting a handle on both, people can put their heavy drinking days behind them and go on to live happier, healthier lives.

Positive Sobriety Institute in Chicago specializes in alcohol and drug treatment for professionals in medicine, the law, business and aviation. Offering an environment that is safe, discreet and supportive, our focus is helping motivated adults regain their health, restore their relationships and resume their livelihoods. Professionals come to us from all over the country for the expertise of our multidisciplinary team, which is comprised of addiction psychiatrists, physicians, nurse practitioners and licensed professional counselors who are dedicated to helping men and women recover.

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Positive Sobriety: The Book
Daniel H. Angres, MD

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