High-Functioning Alcoholism: Signs, Symptoms, and When to Get Help
Many people with Alcohol Use Disorder continue to succeed at work, care for their families, and appear to have everything under control. But functioning isn't the same as thriving. Learn how to recognize the hidden signs of high-functioning alcoholism and why getting help doesn't have to wait for rock bottom.
For 13 years of my life, I abused alcohol without having a clue that I was an alcoholic. The thought never even occurred to me. Sure, I exaggerated every once in a while and I liked to drink every weekend, and sometimes on weekdays too, but that's normal, right? I only realized something was wrong when I developed depression. Then I could clearly see how my alcohol use was worsening my depression. Eventually I seeked professional help to quit drinking.
What is high-functioning alcoholism?
Before we get into high-functioning alcoholism, let's first establish what Alcohol Use Disorder (AUD) is. You can find the complete article in our Education section. AUD is a condition where someone finds it difficult to stop or control their drinking despite the harm it causes. The following signs and symptoms are used by the DSM-V to diagnose AUD in patients:
Ended up drinking more or for longer than intended
Tried unsuccessfully more than once to cut down or stop drinking
Spent significant time drinking or recovering from its effects
Experienced cravings that are so powerful that they take over other thoughts
Allowed drinking to get in the way of life, work and relationships
Used drinking as a way to cope with conflict with family members or friends
Gave up important activities in their lives due to drinking
Been in physically risky situations while drinking
Turned to alcohol when feeling depressed
Had to drink more and more in order to get the same effects as before
Had withdrawal symptoms when going a few days without drinking
In order to be diagnosed with AUD, it's not necessary to have all the symptoms. Even having one or two for a long period of time could lead to a diagnosis. Remember that only a medical professional can correctly make this diagnosis.
AUD doesn't happen from one day to the other. As I mentioned, I led a normal life for 13 years before realizing that I had a problem. Many people display several of the above-mentioned signs of alcoholism yet do not understand that they may have a problem. Even those around them might not realize it. When I told my best friend that I was an alcoholic, she didn't even believe it because she couldn't see that my drinking habits had become pathological.
You don't just wake up one day as an alcoholic. It starts slowly and progressively gets worse with time. AUD is considered as having three phases: mild, moderate and severe. A person can live an entire lifetime with mild or moderate AUD and never realize it. They are what many people call “High-Functioning Alcoholics".
According to the American Addiction Center, a high-functioning alcoholic is someone who "may be able to carry out daily tasks of living (such as job tasks, hygiene, childcare, paying bills, and participating in social activities) without exhibiting the full range of clinical impairments commonly associated with Alcohol Use Disorder (AUD)". In other words, the person with AUD leads a seemingly normal life despite their abuse of alcohol.
High-functioning alcoholism is not a medical diagnosis per se. Again, the correct term is “AUD". However, this term is used when the effects of AUD have not disrupted the person's lifestyle.
Many people “seem” successful, so how can they be alcoholics?
What does "high-functioning" actually mean?
As I mentioned before, the person with AUD continues to drink alcohol despite the harm it causes. A lot of people tend to cling to other areas of their lives as a way to counterbalance the harmful effects that their alcohol use brings them. The opposite is also true—people may use alcohol to counterbalance harmful effects from other areas of their lives. Many people use alcohol to numb themselves or self-medicate. They use alcohol as a coping mechanism instead of dealing with problems head on.
A person with high-functioning alcoholism may be able to hold a demanding job, run a successful business. They may be able to have long-term relationships and families, and raise their children. They can pay their bills, excel academically and be successful in other areas of their lives. All while dealing with a drinking problem.
The fact that their lives seem normal doesn't mean that their relationship with alcohol is healthy. People with AUD may be able to control their drinking in the beginning, but as the disease progresses, it gets harder and harder to control the urges and the cravings. Slowly, the alcohol use starts to impact their daily lives. But until then, their drinking mostly goes by undetected.
Common signs of high-functioning alcoholism
OK, we've covered the basics of AUD and high-functioning alcoholism. You're now probably wondering what that looks like in practice. Here are a few signs of high-functioning alcoholism:
Drinking every day: Maybe you grab a beer when you come home from work. Maybe it's a glass of wine every lunch or dinner. It starts as a subtle recurring behavior, which later can evolve into a habit.
Needing alcohol to relax: You come home from work stressed and you need a drink to “cool down". Your partner left you, so now you need a drink. You start to become unable to cope with stress and other strong emotions without the aid of a mind-altering substance.
Looking forward to drinking all day: You're the first one to ask your team if you're getting together for after-office drinks. You want everyone to hurry up so you can get to the bar quickly. You rush through your tasks because you need a beer. Alcohol slowly starts taking up space in your mind.
Making rules about drinking but breaking them: You said you weren't going to drink on weekdays anymore, but man today was rough. Just one beer. You promised to keep it cool at your cousin's wedding, but it was too much fun so you exaggerated. You create your own rules but are unable to follow them because the urges are too strong.
High tolerance: Everyone is drunk, but you're still standing because you're “strong”. You can drink more because you “don't really get drunk anymore". As your relationship with alcohol evolves, your body starts to develop tolerance to the drugs, making you need to drink more in order to get the same effects as before.
Hiding how much they drink: You don't drink that much, but also nobody really sees how much you drink. You have a beer before heading out to the bar and you have another one when you come home. You start drinking in secret because you don't want people to know how much you actually drink.
Planning social events around drinking: You are always the one to suggest a bar, a club or a dinner party. You never want to grab a coffee or go to the movies. You don't want to spend too much time without drinking so you're always looking for activities that involve alcohol.
AUD doesn't come at once and disturb your entire life. It creeps up on you. It starts slowly until it becomes a habit. The habit evolves into obsession, which evolves into addiction. There is no clear divisive moment that showcases exactly when you go from just a regular drinker to having AUD. The high-functioning alcoholic is somewhere in the middle. Alcohol has already taken up a large part of their lives, but it hasn't generated losses yet.
Why it's so difficult to recognize
Everyone drinks. Many people drink A LOT. Many people get very drunk.
How can you tell when a drinking habit has become pathological? As I mentioned earlier, my best friend didn't believe I was an alcoholic for years. She drinks a lot herself and her idea of my drinking habits was that they were the same as hers. But she didn't know what went on inside my house and inside my head.
We start by thinking that our drinking is normal. Then the little signs shown above start to show, one by one. Still, we believe that everything is OK. The reason so many people with AUD need to hit rock bottom before seeking treatment is because they fail to recognize that they are dealing with an addiction. Again, how do you know when your drinking has gone too far?
If you compare yourself to the “stereotypical alcoholic”, you might not recognize yourself. We tend to think of people with AUD as those who are always drunk, unkept, unable to hold down a job, drinking in the middle of the day, and with no family or friends. That's what we see in the media and pop culture. It's what the movies show us. But it's not the truth. When it comes to AUD, there are no stereotypes. Anyone can have it.
You may think that because you still have your job, that you don't have AUD. You haven't lost your family or friends, you never drink in the morning. Of course you don't have AUD. Your friends drink just as much as you, why would you have AUD and not them?
Like I said, everybody drinks. Alcohol is the one drug that is not stigmatized by society, even though it's one that causes the most harm, along with cigarettes. According to the organization OurWorldInData, alcohol kills around 1.62 million people per year whereas all the other drugs combined kill around 660 thousand people per year, worldwide.
Society rewards heavy drinking. No wonder so many people suffer from AUD without realizing it. It's more unusual if you don't drink. It's like trying to figure out who has a cake-eating disorder when everyone in the room is holding a piece of cake.
Why high-functioning alcoholism is easy to hide
Most people are unable to pinpoint who is a high-functioning alcoholic around them. This is due to the fact that because they are high-functioning, it means that alcohol has not yet affected their day-to-day lives. When AUD becomes visible to others, it's because it is increasing in severity.
As a recovering alcoholic, I can guarantee that it's easy to hide your alcoholism. Mostly because you're hiding in the jungle among other people who also drink. You blend in. No one notices that you ordered another drink after the check arrived. It doesn't raise any red flags that you got drunk at the office Christmas party.
AUD starts internally. It starts with your thoughts. More and more they are focused on alcohol and drinking. You start making decisions around alcohol. Later, the alcohol starts to protagonize your life, but you keep it hidden. You drink mostly at home. You drink without getting drunk. You keep your responsibilities under control. You never miss a day of work or your daughter's soccer practice.
The truth is that you become skilled at masking your symptoms. Around this same time, you also become skilled in lying to yourself.
The hidden costs
Being high-functioning doesn't mean that there are no consequences. Even though you are leading a normal life while dealing with your increasing alcohol use, the effects start to compound.
By the time I admitted that I had a drinking problem, I had developed depression and anxiety, gained 20kg, lost almost every job I ever had and sent several partners running. But that was just my rock bottom. The signs started much earlier.
One of the tell-tale signs of AUD is when you need to use alcohol in order to cope with problems and emotions in your life. When you are unable to just feel happy, angry or sad on your own, things are evolving. You start drinking as a way to deal with issues in your life, or numb yourself from the pain they cause. This causes these problems to build up until one day things explode.
Your alcohol use may cause you to gain a lot of weight or lose a lot of weight. It may keep you from eating healthy and doing physical activities. You may start to sleep poorly and spend the entire day feeling tired. Soon, your productivity starts suffering. A lot of type-As realize something is wrong when their work starts to suffer.
With time, your relationships will be affected by the drinking. You may find you are distancing yourself emotionally from people close to you. You start lying about what's going on in your life. You are constantly thinking about drinking or constantly hung over. Alcohol slowly takes over your entire life.
What we call high-functioning alcoholism is many times a bomb waiting to go off.
High-functioning doesn't last forever
Alcohol dependence evolves over time. It's impossible to predict how fast it will evolve. People can spend years living with mild alcohol dependence and then a life-changing event might change that in a moment. In my case, I would say that I had moderate AUD for 13 years. Then, when I developed depression, my alcohol dependence worsened and became severe.
Many people can maintain the appearance of control for years, but it doesn't mean that they are doing well. The “appearance of control” is not the same thing as having actual control. Over time, control begins slipping away more and more.
One of the first signs that things are evolving it when your tolerance to alcohol starts increasing. The more you drink, the more your body becomes accustomed to dealing with the intoxicating effects and it will take larger quantities to get the same effect as before.
Soon, you'll find yourself drinking at times that aren't considered “healthy drinking times", like early in the morning, or on a Tuesday night after work. At this point, you might also start scaling the quantity.
The consequences start to show eventually—the hangovers, the smell of alcohol in your breath, coming in late for work, unable to concentrate, unable to eat or sleep well. As these things worsen, it will take more effort to maintain appearances.
Until one day, you won't be able to pretend that everything is OK.
Can someone be successful and still be an alcoholic?
My paternal grandfather was your stereotypical alcoholic. He was always walking around the neighborhood shirtless, with a bottle of alcohol in his hands. He was always drunk and often aggressive. I never met him. My grandmother left him when she was 23. He was your typical idea of what alcoholism looks like. However, he had a younger brother who was also an alcoholic, but the family only found out many years later.
My grandfather's little brother was your typical high-functioning alcoholic. He was a successful doctor and surgeon who ran a successful medical practice in the city. He was struggling with AUD for years before anyone ever noticed that something was wrong. One day, he was performing a surgery and the nurse noticed that he was trembling. They had to remove him and later discovered that he had been drinking. He was then expelled from his medical practice and had to go into recovery.
Doctors, lawyers, CEOs, teachers, athletes, parents… We can all suffer from Alcohol Use Disorder. This is a disease that does not discriminate and choose. Being successful does not mean that someone doesn't have or can't have AUD. It just means that they haven't lost complete control yet.
How high-functioning alcoholism affects relationships
The person with high-functioning alcoholism isn't always aware of their condition. For a long time they may believe that they have a normal, healthy relationship with alcohol and that everything is going well. Only over time do the signs start to show. Relationships are usually the first to show signs of strain.
Dealing with alcohol dependence while juggling all other responsibilities of life may leave the person with AUD unable to deal with personal issues. This might initially show up as emotional unavailability and general irritability. A partner will start to notice the signs—their loved one will start to seem distant, will avoid hard conversations, will become annoyed at the slightest event. They will prefer to be alone with their drink instead of keeping their partner company.
Soon, they will begin to break promises and to lie. As they slowly lose control of their drinking, they will have to hide their behavior and create stories to explain it. This may cause them to stay at work longer, or to go out to bars before going home. They will become more absent and less considerate.
One of the first signs that loved ones notice are the mood changes. Soon they will be able to see their partners prioritizing alcohol over more important things. When they confront them about their drinking, they will be met with defensiveness. The person with AUD will start canceling plans, they will become more and more isolated and forgetful.
Partners will notice that something is wrong. They will try to start conversations about these new behaviors but the person with AUD will avoid them. Family members will soon start to walk on eggshells around their loved one, afraid that anything they say will trigger an aggressive outburst.
How do you know if it's becoming a problem?
To be direct, high-functioning alcoholism is already a problem. However, many people who live with this condition do not seek treatment because they have the illusion of control. The only way to get past this illusion is by having earnest self-reflection.
Questions such as:
Have you tried to cut back?
Do you spend a lot of time thinking about alcohol?
Has your tolerance increased?
Do you feel uneasy when you can't drink?
Has alcohol become your primary way to cope?
If you answered yes to any of the questions above, then your drinking might be more problematic than you believe. It's time to take a step back and assess your life.
Many people believe that they can't be alcoholics because they are successful. They don't understand that the process is long and goes through various stages before reaching a severe stage. They believe that because they still have control over their life, that everything is OK. These beliefs, however, can delay them in getting help.
Myths about high-functioning alcoholism
Here are some common myths about high-functioning alcoholism:
Myth: Successful people can't be alcoholics.
Myth: Alcoholics drink all day.
Myth: You have to hit rock bottom.
Myth: If no one notices, it's not a problem.
Myth: If you never get drunk, you're not an alcoholic.
Myth: If your life is on track, then everything is OK.
Myth: Alcoholics are the ones who lose everything.
Alcohol Use Disorder doesn't necessarily have to look a certain way or exhibit certain signs. A lot of people that we think may have a healthy relationship with alcohol may actually be suffering from AUD.
Recovery doesn't require rock bottom
There isn't a right moment to take action. The moment you notice something is wrong is the moment you should seek help. Speak to a doctor, share your concerns. Treatment for AUD is much more effective in the beginning stages than at later stages. You don't have to lose everything in order to accept help. Recognizing that you have a problem is actually a strength, not a weakness.
If you seek help now, your life can improve long before any severe consequences appear. You just have to be open to it.
