Hiding Alcoholism: The High-Functioning Alcoholic

man putting alcohol bottle to his head

Alcoholism can be misleading. Perhaps your spouse drinks excessively, but you don’t think he is an alcoholic. After all, he is responsible, takes great care of the family, is loving and more than competent at his job. Society in general would not consider this type of person to be an alcoholic due to stereotypical beliefs surrounding alcoholism. An alcoholic should be disheveled, out of work, maybe even homeless and definitely someone who evokes feelings of pity or disgust, right? That stereotype holds true in a few cases, but not the majority of the time. The truth is that high-functioning alcoholics (HFAs) are commonly middle-aged, intelligent, well-educated and hardworking, with stable jobs and families. They can drink large amounts and maintain an outward appearance of normality.

Alcoholism Facts and Stats

  • About 30% of HFAs have a genetic or generational history of alcoholism and about 25% experience a major depressive illness at some point in their lives.1
  • In 2014 there were 139.7 million current alcohol users ages 12 or older in the U.S., with 23% classified as binge drinkers and 6.2% as heavy drinkers.2
  • The vast majority (90%) of people who binge drink are not alcoholics or alcohol dependent.3
  • About 23% of adult men reported binge drinking five times a month, averaging eight drinks per binge.3
  • About 12% of adult women reported binge drinking three times a month, averaging five drinks per binge.4
  • Of the estimated 17.6 million U.S. adults with alcohol use disorder, about 19% to 25% are classified as highly functioning or functionally dependent.1,5

The Role of Denial

Denial is the most common trait in functional alcoholics, and often in those closest to them. Denial can lead to an unraveling of the alcoholic’s life and deterioration in daily functioning. It simply isn’t possible to drink heavily over a long period of time and maintain major responsibilities. While the balancing act may continue for a long time, the consequences of heavy drinking ultimately come to light. Possible scenarios leading to risky repercussions include an airline pilot nursing a hangover, a surgeon with shaky hands or a banker handling large sums of money. In some cases, a tragic incident such as a drunk driving accident forces the HFA to enter a treatment program or lose everything near and dear to them.6

Tolerance: The Key to Functioning

When people drink large amounts of alcohol on a regular basis, the liver adapts by breaking down the alcohol more rapidly than in people who rarely drink. Likewise, when neurotransmitters in the brain are regularly exposed to large amounts of alcohol, they begin to adapt to its presence. Alcohol affects the GABA neurotransmitter by causing sleepiness and reduced anxiety and alertness. With long-term exposure to alcohol, the GABA neurotransmitter adapts and more alcohol is required to attain the same effects.7 Tolerance to alcohol is recognized as a potential factor in alcohol abuse and dependence by encouraging the use of escalating doses. Studies indicate at-risk drinkers display less alcohol-induced impairment of motor coordination compared to non-risk drinkers. It is theorized that a history of binge drinking leads to greater acute tolerance to the impairing effects of alcohol on motor coordination and reaction time.8

Signs of a Functioning Alcoholic

There are many signs or signals to watch for if you suspect someone is a functional alcoholic. A person may justify their drinking with what seems like reasonable explanations or get upset when family members question their drinking. Other signs to watch for include:

  • Drinking instead of eating meals
  • Drinking to induce relaxation or confidence
  • Excessive drinking during social engagements
  • Waking up without a hangover, even after several drinks
  • Being irritable, nervous or uncomfortable when not drinking
  • Significant behavioral changes while under the influence of liquor
  • Inability to control the amount consumed, even when they set limits
  • Periods of memory loss or blackouts
  • Concentration difficulties
  • The need to drink alone
  • Continual periods of intoxication
  • Smelling of alcohol in the workplace
  • Hiding evidence of consumption
  • Finishing other peoples’ drinks
  • Missing work or family obligations
  • Obsessing about the next time they will be able to drink6,9

Although functional alcoholism does not meet the diagnostic criteria for alcohol use disorder, it is a serious problem requiring professional intervention. There are many health-related risks associated with excessive alcohol intake, some of which are immediate and others that are long term. These include liver damage, cardiovascular disease, an increased risk of throat, esophageal, liver and breast cancer and several other problems. Alcoholism is a chronic disease that does not get better on its own. If you recognize the signs of alcoholism in someone who seems to be functioning normally, or if you suspect it in yourself, it is time to get past denial and seek professional help.

  1. 5 Lies We’re Told About High-Functioning Alcoholics. Drug Abuse website. http://drugabuse.com/5-lies-were-told-about-high-functioning-alcoholics/ Accessed December 12, 2016.
  2. Alcohol. Substance Abuse and Mental Health Services Administration website. http://www.samhsa.gov/atod/alcohol Updated October 30, 2015. Accessed December 12, 2016.
  3. Fact Sheets – Excessive Alcohol Use and Risks to Men’s Health. Centers for Disease Control and Prevention website. http://www.cdc.gov/alcohol/fact-sheets/mens-health.htm Updated March 7, 2016. Accessed December 12, 2016.
  4. Fact Sheets – Excessive Alcohol Use and Risks to Women’s Health. Centers for Disease Control and Prevention website. http://www.cdc.gov/alcohol/fact-sheets/womens-health.htm  Updated March 7, 2016. Accessed December 12, 2016.
  5. Are You a Functional Alcoholic? Everyday Health website. http://www.everydayhealth.com/sanjay-gupta/are-you-a-functional-alcoholic/ Updated October 28, 2016. Accessed December 12, 2016.
  6. Brody J. High Functioning, but Still Alcoholics. The New York Times. May 4, 2009. http://www.nytimes.com/2009/05/05/health/05brod.html Accessed December 12, 2016.
  7. What Is Alcohol Tolerance? HAMS: Harm Reduction for Alcohol website. http://hams.cc/tolerance/ Accessed December 12, 2016.
  8. Fillmore MT, Weafer J. Acute Tolerance to Alcohol in At-risk Binge Drinkers. Psychol Addict Behav. 2012;26(4):693-702. doi:10.1037/a0026110.
  9. 9 Signs of A High-Functioning Alcoholic. Mind Body Green website. http://www.mindbodygreen.com/0-18440/9-signs-of-a-high-functioning-alcoholic.html Published April 22, 2015. Accessed December 12, 2016.
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