The classic picture of someone with alcohol use disorder is someone who always drinks too much and whose life is falling apart because of it. But it doesn’t always look like it from the outside.
Some people seem to be just fine even though they misuse alcohol. You may hear them called “functional” or “high-functioning" alcoholics. But those aren’t official medical terms.
Although you may still hear people talking about “alcoholism” or “alcohol abuse,” the official term is alcohol use disorder (AUD). It's a condition that ranges from mild to moderate to severe. And it’s all still problem drinking, even if you think it's “mild.” If AUD goes unrecognized and untreated, it’s linked to risks in many aspects of your health and life.
People can have this condition even if they seem to have a great “outside life,” with a job that pays well, home, family, friendships, and social bonds, says Sarah Allen Benton, a licensed mental health counselor and author of Understanding the High-Functioning Alcoholic. They can appear responsible and productive. They might even be high achievers or in positions of power. And their success may lead people to overlook their drinking.
But it doesn’t mean that they’re OK or that their drinking isn’t a problem.
Those who appear “functional” or “highly functional” might not recognize their own drinking problem. They could be in denial, like many other people with AUD. They might think, “I have a great job, pay my bills, and have lots of friends; therefore, I am not an alcoholic,” Benton says. Or they might make excuses like, “I only drink expensive wine” or “I haven’t lost everything or suffered setbacks because of drinking.”
But in reality, they aren't doing fine, says Robert Huebner, PhD, of the National Institute on Alcohol Abuse and Alcoholism. No one, he warns, “can drink heavily and maintain major responsibilities over long periods of time. If someone drinks heavily, it is going to catch up with them.”
What Are the Signs?
What is heavy drinking? For women, it’s having more than three drinks a day or seven a week. For men, it's four or more per day or 14 a week. If you drink more than the daily or weekly limit, you’re at risk.
That's not the only way to tell if you or someone you care about needs help. There are some other red flags. You might:
- Say you have a drinking problem or joke about your alcohol use.
- Not keep up with major responsibilities at home, work, or school.
- Lose friendships or have relationship problems due to drinking, but you don’t quit alcohol.
- Have legal problems related to drinking, such as a DUI arrest.
- Need alcohol to relax or feel confident.
- Drink in the morning or when you’re alone.
- Get drunk when you don’t intend to.
- Forget what you did while drinking.
- Deny drinking, hide alcohol, or get angry when confronted about drinking.
- Cause loved ones to worry about or make excuses for your drinking.
A “functional alcoholic” may seem to be in control. But they may put themselves or others in danger by drinking and driving, having risky sexual encounters, or blacking out, Benton says.
Heavy drinking has many other risks. It can lead to liver disease, pancreatitis, some forms of cancer, brain damage, serious memory loss, and high blood pressure. It also makes someone more likely to die in a car wreck or from murder or suicide. And any alcohol abuse raises the odds of domestic violence, child abuse and neglect, and fetal alcohol syndrome.
How to Get Help
If you think that you or someone you know may be drinking too much, ask your doctor about getting help – whether it’s from a therapist, psychiatrist, or other addiction specialist. Organizations such as the American Society of Addiction Medicine can guide you to help, too. The society has a doctor directory on its website.
In “case management,” a professional may work with you one-on-one. Outpatient programs make it possible for you to get treatment during the day and still live at home.
The most in-depth care allows you to live full time at a treatment facility. These setups can also work along with 12-step programs such as Alcoholics Anonymous. Relating to other people with substance abuse issues may help someone break through denial and begin to recover.