The classic picture of an alcoholic is someone who always drinks too much and whose life is falling apart because of it. But that's not always the reality.
Some people seem to be just fine even though they abuse alcohol. Experts call these people “functional” or “high-functioning" alcoholics
You can still be one even though you 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.
Although it’s now officially called “alcohol use disorder,” you’ll still hear a lot of people talking about “alcoholism” or “alcohol abuse.” 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.”
A functional alcoholic might not act the way you would expect him to act, Benton says. He might be responsible and productive. He could even be a high achiever or in a position of power. In fact, his success might lead people to overlook his drinking.
He could also be in denial. He might think, “I have a great job, pay my bills, and have lots of friends; therefore I am not an alcoholic,” Benton says. Or he might make excuses like, “I only drink expensive wine” or “I haven’t lost everything or suffered setbacks because of drinking.”
But he isn’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 problem or joke about alcoholism
- 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
Functional alcoholics may seem to be in control, Benton says, but they may put themselves or others in danger by drinking and driving, having risky sexual encounters, or blacking out.
Heavy drinking has a lot of 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
The treatment for a high-functioning alcoholic is the same as for any other type of addict, Benton says. Ask your doctor about getting help -- whether it’s from a therapist, psychiatrist, or other addiction specialist. Organizations like the American Society of Addiction Medicine can guide you to help, too.
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.