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Identifying A High Functioning Alcoholic: Know the Signs and Risks

Medically reviewed by Dr. Po-Chang HsuAugust 12, 2024
Written by
On August 12, 2024

Table of Contents

Key Points

  • The high-functioning alcoholic is not a medical term. However, it is used informally to describe someone who is dependent on alcohol but appears to be functioning successfully in their daily lives.
  • Despite their capability to complete daily tasks, they may still have a diagnosable alcohol use disorder.
  • Consulting a health professional is the best way to determine the severity of alcohol use disorder.
  • High-functioning alcoholics are at risk of the same health concerns and negative outcomes as anyone who struggles with a drinking problem despite their high productivity.

High Functioning Alcoholic: The Informal Label

High-Functioning Alcoholic is an informal term for someone dependent on alcohol but still able to function in their daily life, effectively completing their responsibilities and expectations. They often meet the key diagnosis criteria for alcohol use disorder, as their ability to control their alcohol consumption can cause issues in the social, occupational, or relational areas of their lives. They typically meet enough criteria to be diagnosed with AUD. 

A high-functioning alcoholic is not a recognized medical diagnosis and instead falls under the category of alcohol use disorder. Alcohol use disorder has a range of symptoms and severity.

Understanding Alcohol Use Disorder

Alcohol use disorder (AUD) is a problematic pattern of alcohol use. AUD is a treatable medical condition. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis of AUD includes the following eleven criteria. Depending on the number of criteria a person meets determines the severity of their AUD. The severity of the disorder is based on the number of criteria the person meets: mild = 2-3 symptoms, moderate = 4-5 symptoms, or severe = 6 or more symptoms.

The eleven symptoms asked over the past year have you: [1]

  1. Drank more alcohol or drink over a longer period than you intended to.
  2. Wanted to cut down or control alcohol use or tried to stop and were unsuccessful?
  3. Spent a lot of time on activities to get alcohol, use alcohol, or recover from alcohol?
  4. Had a strong craving or urge to use alcohol?
  5. Failed to fulfill responsibilities at work, school, or home because of your alcohol use?
  6. Continued to use alcohol even though it was causing social or interpersonal problems with family and friends?
  7. Given up important social, occupational, or recreational activities because of your alcohol use?
  8. Used alcohol in a situation where it was physically dangerous?
  9. Continued to use alcohol even though it was causing you physical or psychological health problems?
  10. Had to increase the amount of alcohol you drink to achieve the desired effect or intoxication? Or did you find that the regular amount you drank no longer had the same effect?
  11. Experienced withdrawal symptoms as the effects of alcohol wear off?

Functional Alcoholism

Functional Alcoholism is one sub-type of alcohol use disorder. According to a 2007 study, approximately 19.4% of those with alcohol use disorder could be labeled functional alcoholics.[2]   The 2007 study found that people who fell in this category of alcohol use typically were middle-aged; a third had a family history of alcohol use disorder, a quarter had major depression, and outside of smoking, there was a low use of other substances. The label of functional is assigned to a person with this type of alcohol use disorder because, on the outside, they do appear to be functioning. They are married, have meaningful family and social relationships, have jobs, many have college degrees, and have a mid-to-high family income.  

They typically drink every other day and consume five or more drinks on over half of those days, with some days being as high as ten drinks a day. Only 17% of the people who fall in the functional alcohol use disorder category sought help for their drinking, according to the 2007 study.[3]   Of those who did, they usually participated in 12-step support groups such as Alcoholics Anonymous or sought treatment from private healthcare professionals. Despite their level of functioning, they are at significant risk for health issues linked to that alcohol use disorder. 

Physical Health Conditions

Numerous physical health conditions are caused or exacerbated by alcohol use. For some high-functioning alcoholics, these are the first indications that they have alcohol use disorder. These alcohol-use health conditions include liver disease, digestive problems, heart problems, diabetes complications, sexual dysfunction, eye problems, bone damage, neurological problems, weakened immune system, increased cancer risk, birth defects if pregnant, and problems with medications interacting with alcohol.[4]    

Characteristics of Alcohol Use Disorder in a High-Functioning Alcoholic

High-functioning alcoholics can have a variety of different characteristics, and these may change over time. Typical characteristics may include: [5]  

Denial

  • They do not fit the stereotypical ideal of an alcoholic, so they have difficulty viewing themselves as one. 
  • They believe they can’t be an alcoholic as they are successful
  • They use alcohol as a reward
  • They justify their alcohol use as a way to relieve stress

Professional and Personal Life

  • They can complete educational expectations 
  • They can maintain and even excel in their employment 
  • They are well respected for their academic performance or job accomplishments

Interpersonal Relationships

  • They maintain family relationships and friendships 
  • They have romantic relationships

Drinking Habits

  • One drink sets off an alcohol craving
  • Obsessive thoughts about the next drinking opportunity
  • Experience a personality change or have compromised morals when intoxicated 
  • Repeatedly have undesired drinking patterns and behaviors

Double Life

  • They are managing life well, even successfully, to the outside world.
  • Skilled at keeping their professional life separate from their drinking life
  • This may appear to contradict the alcoholic stereotype

Hitting Bottom

  • Experience few consequences or losses due to their drinking alcohol
  • Minimizes alcohol use because they have not hit bottom or lost everything

Denial

Many people who may fall in the category of high-functioning alcoholics are not viewed by others as being alcoholics because, from the outside, they appear successful or have even been overachievers throughout their lives. Their success may also increase their denial and that of family members and friends. 

Because of their denial, they often are undiagnosed and do not receive the physical or mental health care they may need.

Health and Wellness Risk Factors of Alcohol Use Disorder

Risk factors for alcohol use disorder, including people who may currently be higher-functioning, include:[6]

  • Drinking too much regularly over an extended period.
  • Having a family history of alcohol use disorder.
  • Having a mental health disorder, particularly anxiety, depression, schizophrenia, and bipolar disorder.
  • Having a history of trauma.
  • Having a social group that normalizes regular alcohol use.

Treatment Options for High-Functioning Alcoholics

No matter how well you may be functioning, alcohol use disorder is a serious health condition that can be treated. Many treatment options exist, from inpatient detox to outpatient behavioral therapy. Alcohol rehab addresses your health needs and can be flexible to allow you to continue with your daily responsibilities to your family and work.

Medical Content Writer

Amanda Stevens is a highly respected figure in the field of medical content writing, with a specific focus on eating disorders and addiction treatment. Amanda earned a Bachelor of Science degree in Social Work from Purdue University, graduating Magna Cum Laude, which serves as a strong educational foundation for her contributions.

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Frequently Asked Questions About Functioning Alcoholics

One drink is defined as:[7]

  • Beer: 12 oz (at 5% alcohol)
  • Wine: 5 oz (at 12% alcohol)
  • Liquor/Spirits (Rum, Tequila, Whiskey, etc): 1.5 oz (at 40% alcohol)

While no amount of alcohol is labeled as safe, the recommended daily intake, should you choose to consume alcohol, is 1 drink per day for women and 2 drinks per day for men. Heavy drinking or binge drinking is defined as four or more drinks on one day or eight or more drinks per week for women and five or more drinks on one day or fifteen or more drinks per week for men.[8]

If you have a loved one who is struggling with alcohol use disorder, even if they appear to be high-functioning alcoholics, they are still putting their physical and mental health at risk. You may wish to attend an Al-Anon meeting for family support. You can also encourage your loved one to seek medical advice for any health conditions they may struggle with. Sometimes, starting a conversation with a medical professional about one’s physical health concerns is easier than starting a conversation about alcohol addiction.

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[1] U.S. Department of Health and Human Services. (2021, April). Alcohol use disorder: A comparison between DSM–IV and DSM–5. National Institute on Alcohol Abuse and Alcoholism. Retrieved from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm on 2024, June 18.

[2,3] Moss, H. B., & Chen, C. M. (2007). Subtypes of Alcohol Dependence in a Nationally Representative Sample. Drug and Alcohol Dependence, 91(2-3), 149. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094392/ on 2024, June 18.

[4,6] Mayo Foundation for Medical Education and Research. (2022, May 18). Alcohol use disorder. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243# on 2024, June 18.

[5] Benton, S. A. (2009, January 21). Characteristics of high-functioning alcoholics. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/the-high-functioning-alcoholic/200901/characteristics-high-functioning-alcoholics on 2024, June 18.

[7,8] ​​U.S. Department of Health and Human Services. (2022b, May 6). The basics: Defining how much alcohol is too much. National Institute on Alcohol Abuse and Alcoholism. Retrieved from https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/basics-defining-how-much-alcohol-too-much on 2024, June 18.

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