The terms “high-functioning alcoholic” or “functional alcoholic” have been previously used to describe someone struggling with alcohol use disorder (AUD) while still being able to maintain a job, friendships, and family life.
However, this and other related misnomers such as “functional alcoholic” are no longer used because of the potential stigma that can prevent someone from seeking help.
You could have AUD even if you are able to keep a relatively normal life if you fulfill
According to the DSM-5, you
- resolve to drink less or just have “two drinks,” but are never able to control alcohol use
- continue to drink, even though it makes you feel anxious or depressed
- spend a significant time outside of work drinking, buying alcohol, or recovering from drinking alcohol
- have strong cravings to drink when not drinking
- give up important responsibilities or activities you once enjoyed in order to get drunk instead
- engage in dangerous activities while drinking, such as driving, swimming, or unprotected sex
- develop a tolerance to alcohol so you have to drink more and more to feel drunk
- experience withdrawal symptoms when you aren’t drinking. Examples include sweating, shaking, or feeling sick to your stomach.
- have a desire to stop drinking, but feel like you can’t
- feel that drinking negatively impacts your role at home, in the family, your job, or your schooling
- continue to drink despite it causing problems between you and your family or friends
When is someone considered high functioning?
Because of the stigma associated with terms like “alcoholism,” you might have negative ideas about what it means to have AUD.
For example, you might imagine an “alcoholic” as someone who is constantly near-blackout drunk, and someone who’s unable to maintain a job or family life.
However, this kind of stigma is in large part the reason the DSM-5 is no longer using the term in favor of AUD.
It is not uncommon for individuals with AUD to experience conflict with family and friends, and have drinking negatively impact their job, schooling, and overall safety. For this reason, these factors are a part of the diagnostic criteria.
However, there are individuals that meet the criteria for AUD but do not experience these impacts.
Since you only need to fulfill
There are no official diagnostic criteria for what it means to be high functioning. For this reason, it is hard to determine exactly how many people might have high-functioning AUD.
There is research showing that about 19.5 percent of people with AUD are middle-aged, well-educated, and have stable jobs, homes, and families. This could include people with high-functioning AUD, but these criteria are not definitive characteristics.
In addition, according to the
- Binge-drinking:consuming more than four drinks on one occasion for women, and five or more for men
- Heavy drinking: consuming eight or more alcoholic beverages for women, and more than 15 for men.
Although you might not hit all the criteria for the condition, and the impact on your life may appear minimal, AUD is
Often, people with AUD may hesitate to get help because they fear judgment. It’s important to remember that doctors are medical professionals. Their job is to help you get better.
A doctor may classify your AUD as either mild, moderate, or severe based on the number of symptoms you have experienced in the past year,
- Mild AUD: Having two or three symptoms
- Moderate AUD: Four to five symptoms
- Severe AUD: Six or more symptoms
A doctor may also diagnose AUD by asking about your health history and drinking patterns. They may also ask you how much you drink on a regular basis. If you give permission, they may speak to your family or loved ones regarding how much you drink.
If needed, your doctor may also order blood tests to check your liver function.
Your doctor may also conduct imaging tests if other laboratory studies come back abnormal. For example, a computed tomography (CT) scan tests for liver enlargement, which can occur after years of chronic drinking. Your doctor may order this test if your blood tests indicate abnormal liver functioning.
If people with high functioning AUD do not get treatment, the disease may progress to a point at which their dependence significantly impacts their day-to-day lives.
Eventually, the complications associated with AUD may include:
- difficulty falling or staying asleep
- difficulties with sexual relations
- alcohol-associated liver damage
- brain damage
- gastrointestinal bleeding
- high blood pressure
- alcohol withdrawal syndrome
AUD may also
Since people with high-functioning AUD can be on the milder spectrum of the condition, the earlier treatment happens, the more it may be possible to avoid a progression.
There are a number of ways to approach AUD treatment:
Medications that can help treat AUD include:
- naltrexone (Revia): This helps block brain receptors that trigger the desire to drink alcohol. You take it as a pill. When you take it as an injection, it is sold under the different brand name Vivitrol.
- acamprosate (Campral): This can help reduce cravings while you are abstaining from drinking alcohol.
- disulfiram (Antabuse): This causes you to feel ill every time you drink alcohol. Symptoms can include nausea, headaches, and vomiting.
Treatment for AUD may involve detoxing. This can cause harmful symptoms in longtime heavy drinkers. It’s recommended that you do this at a hospital or inpatient treatment facility.
- rapid heart rate
- severe nausea
- difficulty sleeping
For some people, AUD may also mean more than physical dependence, but a stress reliever or source of psychological escape.
This is why psychological counseling, such as talk therapy, is important if you’re recovering from AUD. This can help you learn new coping skills so you can turn to other behaviors instead of drinking in order to live a healthier life.
A counselor trained in treating alcohol use disorder may:
- help you understand and treat any psychological issues that may triggering your AUD
- help you identify external triggers in your life that may be contributing to your AUD
- teach you behavioral changes you can use to support your recovery
- help you establish an ongoing treatment plan
- monitor your progress and support on your treatment journey
Both residential and outpatient day treatment programs are available for those in recovery.
For people with functioning AUD, seeking treatment as an outpatient may help them reduce disruptions to their work or family life.
However, a doctor should recommend the best type of treatment for each person since the severity and presentation can vary from person to person.
A number of resources can help you or a loved one get into recovery or continue your sobriety. These include:
- The National Council on Alcoholism and Drug Dependence
- Hazelden Betty Ford Foundation
- Alcoholics Anonymous
How to help a person with AUD?
People who are close to a person with AUD may need support to understand how to help their loved ones.
In addition, since the impact of AUD may not be as obvious, the person may be unable to recognize the severity of their condition in these early stages.
Reaching out to support groups for people who are close to someone with AUD can help. These include:
If you have AUD but are not connected with treatment, the risk of progressing to more severe AUD is much greater.
The longer you live with AUD, the higher your risk of developing complications that can lead to death. According to 2020 data by the CDC, nearly
In addition, there were almost 50,000 other alcohol-related deaths. These numbers do not include people who have died in alcohol-related accidents or violence, so the overall number is likely much higher.
The good news is that seeking treatment can help. Managing AUD is a lifelong process, so the earlier you or your loved one seeks help, the more likely you are to succeed in overcoming the disorder and limiting recurrence.
“High-functioning alcoholic” is no longer a term used by medical and mental health professionals, due to the stigma associated with the term. The DSM-5 instead uses the term alcohol use disorder, or AUD, to describe an addiction or dependence on alcohol. The condition can range from mild to severe.
People who live fully functional lives can still have AUD and can benefit from treatment and support. The condition causes