A high-functioning alcoholic is a person who holds onto their job and their family and avoids negative consequences to their life despite having an addiction to alcohol. Sometimes the pressure and success of the outwardly perfect appearance of their lives drives them to drink more, pushing their body and their relationships to the brink. Other times, they can compartmentalize or hide their drinking from those close to them.
It’s important to note that the term "alcoholic" is outdated and stigmatizing toward people with this condition. The formal term for someone with this disorder is alcohol use disorder. A person-centered and compassionate approach to this condition is to say "a person with alcohol use disorder" rather than "alcoholic."
What is a High-Functioning Alcoholic?
A high-functioning alcoholic (also simply known as a functioning alcoholic) is a colloquial term for a person who is able to maintain a personal and professional (or academic) life while still meeting the criteria for alcohol use disorder (AUD).[2]
They are distinct from moderate drinkers, who don’t drink compulsively and are able to control their drinking. High-functioning alcoholics are also distinct from the model of the traditional alcoholic, who is unable to maintain a work/school and/or family life because of their alcohol use.
However, alcohol use disorder, the diagnostic term for alcoholism, exists on a spectrum, ranging from mild to severe. [2] High-functioning alcoholics may simply fall on the milder side of the spectrum. That said, alcohol addiction is progressive, which means the longer someone continues to abuse alcohol, the more severe their condition will get.
One study found that as many as 75% of those with AUD are able to function in many parts of their lives. [1]
One study indicates that about 20% of people who meet the criteria for alcohol addiction appear to be high-functioning to others. Another estimates that as many as 75% of those with alcohol use disorder are capable of functioning in many parts of their lives.[1]
High-Functioning Alcoholic Signs
While high-functioning alcoholics present as though they don’t have a problem with alcohol at all, they may exhibit or experience some or many of the typical signs of alcohol use disorder, such as:[1],[2]
- Experiencing cravings for alcohol (although they may hide it or excuse the cravings)
- Experiencing functional tolerance (being able to “hold their liquor”)
- Drinking more or for longer than intended (binge drinking)
- Becoming irritable and hostile when they do not have access to alcohol
- Making up reasons to drink, such as celebrating a success or coping with stress
- Being unable to drink in moderation
- Spending a lot of time drinking or doing activities revolved around drinking
- Lying about their drinking habits and covering up evidence thereof
- Exhibiting impulsive and risky behavior (like pursuing illicit relationships or engaging in other forms of compulsive behavior like gambling and occasional drug use)
- Avoiding feedback or input about their drinking
- Experiencing blackouts.
- Continuing to drink even if their drinking has caused or exacerbated mental health or physical problems
- Denying that they are an alcoholic because of the lack of consequences
- Putting a lot of effort into presenting well and being well-groomed
- Drinking during the day, such as during lunch at work
- Drinking in hazardous situations, such as before driving
- Balancing work, life, and home responsibilities despite alcohol abuse
- Comparing themself to someone with a worse drinking problem than them
- Having a reputation for doing an excellent job at school or work despite compulsive drinking
- Obsessing over when they can drink next
- Justifying why it’s okay to drink at certain places
Those are the signs to look out for to tell if someone is a functional alcoholic. It may be harder to notice in such a case because a functional alcoholic will become very adept at disguising their drinking.[3]
If alcohol plays an outsized role in their lives, it doesn’t matter how well they are able to hold their family and their professional lives together. They still have a form of alcohol use disorder, and the problem needs to be corrected before something terrible happens to them or their health. Early treatment is crucial to helping a person obtain and maintain long-term recovery—it’s never too early to seek alcohol rehab.
Disguising and Denial: Hallmarks of High-Functioning Alcoholism
Alcoholism can present itself in many forms. High-functioning alcoholism can be one of the most insidious presentations of alcohol use disorder because it bucks the conventional trends of the condition.
A high-functioning alcoholic who sees no issue with their alcohol intake will strongly reject the notion that their drinking is problematic at all, making it all the harder to convince them to discontinue the behavior and get help.
High-functioning alcoholics can convince themselves and others that they are not alcoholics because their drinking does not disrupt their home or work lives. Some go so far as to justify their behavior because of that reason, arguing that they deserve to drink (even to excess) because of their success, or that their personal and professional success entitles them to drink as much as they want, whenever they want.
In some cases, high-functioning alcoholics might not even know that they have alcohol use disorder. They have become so good at maintaining their responsibilities and their drinking habits that it might legitimately never occur to them that their drinking is compulsive or problematic. Even if they don’t realize the scope and extent of their problem, the fact that alcohol has such a dominant presence in their lives is what qualifies them to be functional alcoholics.
Denial is a significant component of high-functioning alcoholism and one that makes recognizing its signs so difficult. As the severity of the alcohol abuse deepens, so too does the denial. [4]
High-Functioning Alcoholism vs. Other Types of Drinkers
There are some major differences between high-functioning alcoholics, severe alcoholics, and moderate drinkers, but you will also notice some overlap between signs of a functioning alcoholic and someone with severe alcohol use disorder. This is because high-functioning alcoholism is still alcoholism (and the person may not always be functioning).
| High Functioning | Moderate Drinking | Severe AUD |
|---|---|---|
| Hides drinking | Doesn’t hide | Hides drinking |
| Functional tolerance | Typical tolerance | High tolerance |
| Performs well at work | Drinking doesn’t interfere with work | May have poor work performance or miss work |
| Often drinks more than planned | Drinks 1-2 drinks in a sitting | Often drinks more than planned |
| In denial because of lack of consequences | Is open about their consumption | Continues to drink despite consequences |
| Makes excuses to drink like celebrations or lunch meetings | Doesn’t make excuses | Makes excuses to drink |
| Has strong cravings to drink | Doesn’t experience cravings or they are limited | Has strong cravings to drink |
| Compare themself to people with worse drinking to downplay their own drinking | Doesn’t compare or defend themself | May make comparisons when confronted |
| May experience withdrawal symptoms but have ways of managing them, such as with a Xanax prescription | No withdrawal symptoms | May experience unpleasant withdrawal symptoms |
| Intentional well-groomed appearance to overcompensate | Well-groomed or typical appearance | Is less concerned with appearance |
| May struggle to control drinking, which results in more and more reasons to drink | Is able to control drinking | Inability to control or cut down on drinking |
Alcoholism is a Progressive Condition
Alcohol use disorder is a progressive condition, which means without treatment, it tends to worsen over time.
Worsening may look like drinking more frequently, drinking more drinks in one sitting, being unable to hide drinking anymore, experiencing distressing withdrawal symptoms, and more.
That’s why many experts tend to prefer to use the term “currently functioning alcoholic” as opposed to a high-functioning alcoholic. It is incredibly difficult to maintain that level of functioning as a person continues to drink. And even if someone is “functioning,” that doesn’t mean they won’t experience the harmful consequences of drinking like severe health complications.
While the term rock bottom tends to be used very loosely when it comes to alcohol addiction, even functional alcoholics will ultimately struggle to maintain the facades they’ve carefully constructed to hide their drinking, eventually resulting in anything from a DUI to some other form of an inescapable sign that their behavior fits the criteria for alcohol use disorder.[5]
Dangers of Long-Term Drinking for High-Functioning Alcoholics
Even if a person who is a functional alcoholic is able to maintain an outward appearance of having it all together, one of the key dangers of functional alcoholism is that unchecked alcohol consumption still takes a physical toll. Dangers of long-term alcohol abuse include: [6]
- Mental health issues, such as anxiety and depression
- Memory and learning problems
- Heart disease
- High blood pressure
- Stroke
- Liver disease
- Cancer of the rectum, colon, liver, voice box, esophagus, throat, mouth, or breast
- Compromised immune system
- Alcohol dependence and withdrawal (and life-threatening withdrawal like seizures)
- Alcohol tolerance
- Risk of alcohol poisoning or overdose
What makes this so dangerous is that a high-functioning alcoholic will become very good at denying any negative effects of their drinking, all while their body is breaking down because of excessive alcohol consumption.
How to Help a High-Functioning Alcoholic
Before it gets to that point, there are ways to guide a functional alcoholic to accept the truth.
How can you help someone who is a functional alcoholic? One of the first things to do is to talk to them when they are not drunk. Choosing a moment when they are hungover or feeling guilty about the way they behaved when they were drunk allows you to expose the veneer that high-functioning alcoholism puts up. This also makes it more likely that the person will agree that their drinking is out of hand, and they will be more amenable to seeking professional help. [7]
Approaching Them with Compassion and Empathy
Talking to someone about their high-functioning alcoholism means telling them that even though outward appearances indicate a successful and happy life, your relationship and your feelings are nonetheless being harmed by their behavior.
Document experiences like arguments, past (failed) attempts at giving up drinking, or a loss of intimacy or closeness as examples of how the functional alcoholism has negatively impacted your life and their life as well.
Any hint that the line in the sand will be conceded may be exploited by the person’s desire to continue drinking.
Take care not to attack your loved one because condemnation or accusations can easily push them toward hostile and defensive behavior. Addiction experts recommend using compassion, appealing to the person’s better self, as a way to motivate them to sincerely want to stop drinking and to seek professional treatment. [8]
But it should always be made clear that if the person does not accept this outreach, or if they secretly renege on whatever assurances they make, the consequences will be swift and complete.
You must be clear, firm, and rapid with your boundaries. One way or another, the person must be convinced to seek help for their functional alcoholism.
High-Functioning Alcoholism is Still Alcoholism and Requires Treatment
Even though functional alcoholism may present itself as a form of alcohol use disorder that is “not so bad” because of how the person is able to manage their professional and personal lives, it is still a condition that requires specialized addiction treatment. [9]
Medical Detox is the First Step of Care
A person who is a functional alcoholic should not simply discontinue their drinking, because they may experience dangerous alcohol withdrawal symptoms if they have a physiological dependence. The best and safest setting to begin on the road to recovery is medical detox.
Medical detox occurs in a hospital or as part of an inpatient alcohol rehab and offers 24/7 medical care, supervision, and monitoring to ensure a patient’s safety. They also administer alcohol withdrawal medications like benzodiazepines to alleviate symptoms and reduce the risk of complications.
Transitioning into Alcohol Rehab
Once stabilized and detoxed, a person with high-functioning alcoholism should transition into a comprehensive alcohol rehab program, such as:
- Inpatient treatment: They live at the facility for between 30 and 90 days and receive intensive, around-the-clock care.
- Partial hospitalization: They live at home and attend counseling for up to 30 hours each week.
- Intensive outpatient: They reside at home and attend between 9 and 20 hours of therapy each week.
- Standard outpatient rehab: They reside at home and attend a few hours of counseling per week. This option is typically used after someone has attended a higher-intensity program like inpatient or partial hospitalization.
A key component of early alcohol addiction treatment may come in the form of motivational interviewing or motivational enhancement therapy, in which a therapist helps to resolve patient ambivalence surrounding attending treatment and increases motivation. This may be especially important for high-functioning alcoholics since many of them may not believe that they have a problem or that they require professional care.
Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More
- Understanding the high-functioning alcoholic: Professional views and personal insights. Benton, S.A. (2009). Westport, CT: Praeger Publishers.
- Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. (2013). Arlington, VA: American Psychiatric Publishing.
- Understanding Alcohol Use Disorders and Their Treatment. (2012). American Psychological Association.
- Denial in Alcohol Use Disorder. (July 2021). Psych Central.
- The Various Ways High Functioning Alcoholics Hit Rock Bottom. (April 2009). Psychology Today.
- Alcohol Use and Your Health. Centers for Disease Control and Prevention (April 2022).
- Ways to Approach the High-functioning Alcoholic in Your Life. (June 2009). Psychology Today.
- How to Have Compassion for an Addict. (October 2016). US News & World Report.
- Treatment of Alcohol Use Disorder. (February 2021). JAMA.
