Even as alcohol consumption has reached historic lows throughout the United States, alcohol use disorder (AUD) still accounts for the vast majority of substance use issues. Boston Drug Treatment Centers, a Massachusetts-based directory of substance rehab facilities, has even reported a rise in inquiries for alcohol rehab following the COVID-19 pandemic lockdowns.

Contrary to pop culture depictions, people with alcohol use disorders come from all walks of life. While most people with alcohol use disorders tend to exhibit obvious behavioral patterns that most laymen could easily identify, functional people with AUD (formerly known as “functional alcoholics) are able to hide their condition and lead a life that is, from all outward appearances, productive and normal.

What are functioning alcoholics?

Functional individuals are among the five subtypes of people with AUD, according to the National Institutes of Health, the other types being Young Adult, Young Antisocial, Intermediate Familial, and Chronic Severe.

A functioning or high-functioning person with AUD is still typically able to maintain personal and professional relationships and may not have experienced any obvious consequences because of their drinking. They may even be pillars of the community and well-loved by friends and family.

However, this doesn’t mean that functioning people do not experience any downsides to their condition. As with other people with AUD, they are typically unable to feel normal without a drink. Functional individuals with AUD may drink daily or binge drink periodically.

Ceasing regular drinking will usually bring on extremely uncomfortable withdrawal symptoms that will cause the individual to resume their alcohol intake. Unfortunately, this usually means that high-functioning people eventually suffer health consequences due to their regular drinking.

Profile of functioning alcoholics

According to the National Institutes of Health, about 1 in 5 Americans with AUD can be considered functional. They are typically well-educated, middle-aged, and may have started drinking heavily later in life. Many have stable jobs and familial relationships, and a large proportion (about half) are also smokers. About a third have a family history of AUD and about a quarter also have depression.

Signs someone may be a functioning alcoholic

It can be very difficult to spot a high-functioning person with AUD. This may be more true in cultures where heavy drinking is commonplace. High-functioning individuals also tend to be educated and intelligent, which often makes them adept at hiding their substance issues from others. They may also be very proficient at hiding their intoxication, even as they perform well in professional and personal relationships.

Only a qualified clinician is qualified to make a diagnosis of AUD. However, if the following signs are present in you or someone you know, you may have a reason to seek medical attention for further evaluation.

Some signs an individual with AUD is high-functioning include the following:

1.) They have a hidden stash of alcohol.

2.) They attempt to hide their drinking from others.

3.) The individual dislikes criticism of their drinking.

4.) They exhibit irritability, restlessness, nausea, cramping, or shakiness when not drinking.

5.) They experience frequent memory lapses.

6.) They need alcohol before attending social events or attempting stressful work.

7.) Sporadic legal problems due to drinking, such as DUIs.

8.) The individual may have blackouts due to drinking.

9.) Denial of a problem, often pointing to acceptable or even exemplary work performance or social status.

10.) The ability to drink large amounts of alcohol and seem normal.

11.) Drinking during work hours.

12.) Drinking before driving, rationalizing that alcohol does not affect them.

13.) Occasionally abstaining for long periods to prove they have no problem.

14.) Acceptable or excellent performance in professional and personal lives.

15.) Drinking more expensive alcohol to justify that they do not have an AUD.

16.) Shame at one’s drinking habits.

17.) May feel the urge to drink only in very specific situations.

18.) The individual does not want to waste drinks, even if they are someone else’s.

19.) Attempting to quit or reduce drinking, implicitly acknowledging the problem.

20.) Comparing oneself to other people with more visible AUD problems as an excuse.

If two or more apply to you or someone you know, make sure to contact a psychiatrist for full diagnostics and to discuss your next step.

What happens if you leave functioning alcoholics alone?

Regular heavy drinking will catch up with a functioning individual sooner or later. While they may continue to evade social and professional consequences for their drinking, health problems are more than likely to eventually result. Liver disease, immune system dysfunction, brain damage, osteoporosis, and several different types of cancer are far more common in heavy drinkers than they are in other people.

For this reason alone, functioning individuals with AUD need to seek treatment as early as possible.

Summary

Functioning individuals with AUD have among the lowest treatment rates precisely because they are much harder to spot than the other AUD subtypes. Their friends, colleagues, and family may not even recognize that there is a problem. Those that do recognize the problem, including the individual themselves, may make excuses to avoid seeking help, citing the seeming lack of any issue with the drinking.

However, this means that these individuals are likely to suffer even worse physical effects from their alcohol use, as they may drink heavily for much longer. It’s only often a matter of time before functioning individuals start seeing serious chronic health issues that may already be too difficult to treat.

Cite this article as:
Editorial Staff, "What You Need To Know About “Functioning Alcoholics”," in Medicalopedia, April 27, 2021, [Permalink: https://www.medicalopedia.org/9700/what-you-need-to-know-about-functioning-alcoholics/].