What Is A Functional Alcoholic?

A functional alcoholic flies under the radar because of their ability to perform at an average or above-average level in society. In other words, this person is able to do their job, have relationships, and manage family obligations despite alcohol use that is harmful.

The term "functional alcoholic" is not a clinical diagnosis or a medical term but used conversationally. High-functioning alcoholic is another way of describing this type of drinking. Both terms are stigmatizing. Addiction does not define a person. Experts say it's best to avoid labeling someone in this way. It's best to refer to the person as someone who is suffering from alcohol use disorder (AUD). The National Institute of Alcohol Abuse and Alcoholism says AUD is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.

It's important to understand that you don't have to drink on a daily basis to have a drinking problem. It's not about the frequency of the alcohol consumption, but the nature of a person's relationship with alcohol—and the way it impacts them physically and mentally—that makes it problematic. That's not to say that some with this problem aren't daily drinkers.

Although a functional alcoholic’s drinking largely goes undetected by others, they may be struggling internally with cravings, withdrawal symptoms, and experience other physical symptoms from their alcohol use.

“The individual is functional so long as alcohol consumption is present, but in its absence, one may become extremely uncomfortable, and the issue becomes more pronounced,” says Matt Glowiak, PhD, a licensed clinical professional counselor.

Functional Alcoholism Defined

As previously mentioned, the term “functional alcoholic” is not a formal diagnosis or a medical condition. The term “alcoholic” is derogatory and using it perpetuates the stigma of alcohol addiction. That's important because stigma and shame can be barriers to treatment. Although alcohol is an addictive substance, the blame is often assigned to the person drinking. Addiction is an illness, not a moral failing or a lack of will power.

The clinical diagnosis for a pattern of drinking that causes distress or harm is alcohol use disorder (AUD).

There are different levels of severity with regard to AUD—mild, moderate, and severe. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as having more than three drinks a day (or seven in a week) for women; four or more per day or 14 in a week, for men. If you drink more than the daily or weekly limit, you’re at risk.

Alcohol use can cause lasting changes to the brain—something many fail to realize. The NIAA defines AUD as “a chronic relapsing brain disorder characterized by an impaired ability to stop or control use despite adverse social, occupational, or health hazards.”

Some high-functioning alcoholics do not meet the criteria for a diagnosis of AUD but are at increased risk of developing AUD. (To be diagnosed with AUD, you must meet two of 11 criteria in the same 12-month period.) You may be surprised to learn that not all heavy drinkers reflect the stereotype of someone whose life is falling apart.

A functional alcoholic is a person with a drinking problem who appears to have it together on the outside but experiences symptoms of AUD (alcohol cravings, for example). They may even perform at high levels at work, causing others to overlook problematic alcohol consumption.

The causes of addiction are complex—a mix of genetic, environmental, and social influences contribute to this heartbreaking disease. While a gene for functional alcoholism doesn't exist, there are risk factors associated with developing an alcohol addiction.

Some risk factors may include but are not limited to:

• Mental health challenges

• History of trauma

• Binge drinking

• Family history of addiction

Here are some red flags associated with problematic drinking behavior (Note: The list of behaviors that follow apply to all people with AUD, not just high-functioning people):

Denial Due to Lack of Awareness

A functional alcoholic may deny and minimize their drinking problem due to an inability to see drinking as the problem. Since alcohol is so normalized in society, the problem (to them) may be their spouse, their boss, their hangovers—anything but their alcohol use. Many need help discovering the harm their alcohol use is causing.

Secrecy

Some people who struggle with an alcohol problem drink secretly. It may be years before family and friends become aware of it.

Secrecy can include hiding empty containers, buying alcohol to replace what they’ve consumed, or spending money on alcohol without their family’s knowledge.

The person may also isolate themselves and drink in private to avoid bringing attention to themselves. “They may feel like they are living a lie,” says Glowiak.

Fluctuating Mood

The person may have difficulty regulating their mood, and some emotions may seem inappropriate or out of context.

Addiction Psychiatrist Bunmi Asana, MD says some notable changes are anger outbursts, being overly anxious or depressed, and being disconnected or disinterested in activities.

In addition, they may attempt to isolate themselves or limit their attendance at activities that don’t involve alcohol.

The person is likely internally struggling to manage their thoughts and emotions, says Glowiak. There may be some cognitive dissonance. They know their behavior is harming them, but they continue drinking.

Justification of Use

It’s common for those considered “functional alcoholics” to justify their alcohol use (again rationalization is a common across all forms of addiction). Since they can function at an average level, they believe they’re “not that bad.”

They may also compare themselves to others to remove the spotlight from themselves and their justification for drinking may be irrational to others.

They may become upset and irritated with those around them when others comment on their drinking. Glowiak adds that they may also try to take on more work, succeed at it, and use that to further minimize their drinking problem.

Tolerance

Heavy drinking over time causes our alcohol tolerance to increase. A person who drinks regularly has to drink more over time to get the same effect.

Those considered functional alcoholics struggle with stopping drinking because they need more alcohol to get the desired effects.

Withdrawal

A person physically dependent on alcohol may struggle to stop or cut back. Withdrawal symptoms can begin six hours after a person’s last drink.

Withdrawal symptoms can keep people drinking long after they admit they have a problem. Many people want to stop but struggle with how to do that. The physical symptoms become so challenging to manage that drinking seems easier.

• Headaches

• Anxiety

• Tremors or shakes

• Insomnia

• Fatigue

• Mood changes

• Gastrointestinal disturbances

• Heart palpitations

• Increased blood pressure or heart rate

• Hyperthermia

• Rapid abnormal breathing

• Hallucinations

• Seizures

Stopping drinking without medical intervention or a detoxification process can be very dangerous and even deadly. If you or your loved one is considering this, consult a medical professional before stopping. (It's important to make sure the healthcare professional is trained in addiction. Many aren't.)

Problematic alcohol use can negatively impact all aspects of a person’s life—it can cause difficulties with loved ones, colleagues, and friends.

Alcohol and Relationships

There may be arguments about whether or not the person drinks too much and how it affects their relationships.

Alcohol and Physical Health

Alcohol is a carcinogen, meaning it can cause cancer. And, according to the CDC, drinking alcohol increases your risk of getting six kinds of cancer.

Dr. Asana says physical changes often stem from lack of sleep, poor self-care, or significant weight changes. She adds that other serious health consequences include high blood pressure, diabetes, and liver damage from heavy drinking.

Alcohol and Mental Health

Alcohol is a depressant. It makes you feel calm and relaxed and lowers your inhibitions. After that feeling wears off, the chemicals in your brain are unbalanced, which can lead to difficulties with mental health.

Regular drinking is linked to depression and worsening anxiety. Drinking alcohol can increase symptoms of depression and interfere with some antidepressant medications.

If you’re concerned about your own alcohol use or the drinking habits of someone you love, here’s what you can do.

Learn About the Effects of Alcohol

Educating yourself about what alcohol does to the mind and body is a great way to understand a person's drinking.

A variety of books, blogs, podcasts, and social media platforms dedicated to living a life without alcohol (also known as sobriety) can inform your understanding of the problem and connect you to virtual communities of support. Hearing other people and families tell their stories about how alcohol has negatively affected their lives can be inspiring and helpful.

Say Something, Even if it Feels Uncomfortable

It can be difficult to broach the subject of alcohol use with someone who doesn’t think they have a problem. Regardless of how uncomfortable it feels, it’s essential for both people.

Glowiak suggests stating the facts and coming from a supportive standpoint. They will likely deny that they have a problem or try to minimize their alcohol use. Be willing to participate in therapy if necessary.

Consider cutting back on your own alcohol consumption as a way to encourage a friend or loved one to drink less.

The first step is admitting there is a problem and having a genuine desire to change it. Without that, healing is difficult and success will be a struggle.

Glowiak says to recognize the dangers of alcohol and the invasiveness of addiction. The earlier the intervention, the better.

Speak to your primary physician (but understand many may not be helpful due to a lack of addiction training), a therapist, or substance use disorder counselor. Clinicians with experience treating addictions, can help you develop a plan to stop drinking and provide resources.

If you’re worried about addressing your alcohol problem in person (or reside in an area , you can participate in treatment, therapy, or mutual help/support groups online.

Remember, you’re not alone. Many people struggling with alcohol consumption need help to stop drinking.

What is a functional alcoholic?

A functional alcoholic is someone dependent on alcohol who appears to be functioning well occupationally (at work) and possibly in other areas despite impairment. The impairment is mild enough that it escapes the attention of others but that doesn't mean it isn't there.

What are the true signs of a functional alcoholic?

It can be difficult to recognize the signs of a functional alcoholic. The impairment may not cause job loss or (completely) destroy important relationships, but that doesn't mean their alcohol use isn't harmful.

Some signs include but are not limited to denial/lack of awareness, secrecy, fluctuating mood, justification of use, tolerance, and withdrawal symptoms. A lack of alcohol consumption may make a person with a drinking problem feel uncomfortable. And when confronted about the problem, they will likely deny or divert the conversation.

If you (or your loved one) meet two (of the 11) criteria—in the same 12-month period—you have AUD. AUD exists on a spectrum from mild to moderate to severe. Many people who have relatively mild to moderate impairment in functioning can have quite severe AUD.

How can I help the functional alcoholic in my life?

Education is key. Learn about how alcohol affects our minds and bodies. Say something to the person, even if it feels uncomfortable. Tell them how much they mean to you, and state the facts. Talk about how their drinking affects their life and your relationship with them. Being honest with them is most important. Some people with an alcohol addiction don't see the alcohol as the problem (instead they blame their spouse, boss, or their hangover) and need help discovering it.

A treatment approach that many addiction experts recommend is Community Reinforcement and Family Training (CRAFT). It's a non-confrontation system (it doesn't involve an intervention) that helps family and friends change the way they interact with someone they love who is drinking (or using drugs) too much.

CRAFT teaches you how to stay connected, increase communication, and effectively encourage your loved one to get treatment while taking care of yourself in the process. Unlike family therapy which includes the loved one with the problem, this approach is just for the friends and family members.

CRAFT uses principles such as kind communication; learning to reward recovery behavior; practicing self-care; offering assistance with recovery as needed; and learning not to enable addiction.

To find a CRAFT-trained practitioner visit Helping Families Help directory of providers.