What Is a High-Functioning Alcoholic?

A high-functioning alcoholic is someone who meets the criteria for an alcohol use disorder (AUD). However, they maintain a relatively everyday personal and work life.

High-functioning alcoholics are also known as functioning or functional alcoholics. They meet at least two of the following criteria:

• They frequently consume more alcohol than intended
• They want or try to cut down on alcohol use but can’t
• They spend significant time or energy to acquire or use alcohol or recover from using alcohol
• They experience a strong desire to use alcohol (i.e., cravings)
• They continue to use alcohol despite physical or mental consequences
• They need more and more alcohol to get intoxicated (i.e., tolerance)
• They experience negative physical or mental symptoms after quitting alcohol use (i.e., withdrawal)

These are criteria mental health professionals use to diagnose alcohol use disorders. Additionally, experts consider the following three criteria when diagnosing AUDs:

1. Continuous use of alcohol despite failing to meet obligations at work, in school, or at home
2. Continuous use of alcohol despite significant interpersonal issues
3. Continuous use of alcohol despite giving up things they used to enjoy

Functional alcoholics do not meet these three criteria. As such, it can be difficult for them and others to identify that they have a problem. They may delay treatment for this reason.

Functional Tolerance

Another reason why loved ones may miss signs of an alcohol use disorder is functional tolerance. Functional tolerance occurs when someone can consume significant amounts of alcohol without appearing intoxicated.

Someone with functional tolerance may drink throughout the day without attracting notice. Or they may consume large amounts of alcohol socially and never display signs of being drunk.

Tolerance happens when someone adjusts to using large amounts of alcohol. Their body pushes back against alcohol’s effects, making them appear normal to others.

Types of Functional Tolerance

There are different types of functional tolerance. They include acute, situational, learned, and metabolic tolerance.

Acute tolerance happens over the span of a single drinking session. The person may seem drunk at first. However, over the next few hours, they may appear less intoxicated despite continuing to consume alcohol.

Situational tolerance is also known as environment-dependent tolerance. It happens when someone consumes alcohol repeatedly in the same place. For example, someone may feel less drunk when drinking at a bar versus at home.

Learned tolerance refers to someone’s ability to perform an activity, typically when intoxicated. They learn to perform the action normally through repetition or by receiving rewards.

Metabolic tolerance can be the most dangerous. Some people experience liver changes from chronic drinking. These changes allow the body to eliminate alcohol more rapidly. This results in the person feeling less intoxicated than they are.

This type of tolerance is dangerous because it can lead to liver damage. People with metabolic tolerance may also experience reduced effects from prescription drugs. The liver learns to metabolize those substances faster, too.

The Difference Between a High-functioning Alcoholic vs a Dysfunctional Alcoholic

The biggest difference between functioning and dysfunctional alcoholics is that the latter struggles to maintain life as normal. They may lose their job or drop out of school because of drinking.

It is much easier for loved ones to identify an alcohol problem in dysfunctional alcoholics. These people may use alcohol while driving or caring for children, which may be dangerous.

Many dysfunctional alcoholics also fail to achieve functional tolerance. People may refer to them as “sloppy drunks.” They may showcase significant signs of intoxication, which may include:

• Slurred speech
• Slowed movements
• Loud speech
• Overly friendly behaviour
• Drinking alone
• Bloodshot eyes
• Sweating
• Flushing
• Getting into arguments
• Becoming belligerent
• Spending money recklessly

Dysfunctional alcoholics must meet two of the criteria we mentioned earlier to receive an AUD diagnosis.

Which Type of Alcoholic Is More Dangerous?

Functioning and dysfunctional alcoholics are both dangerous, though the former can be even more so. Dysfunctional alcoholics can be easier to spot. As such, they may receive treatment before a functioning alcoholic.

Dysfunctional alcoholics may also do less damage to their brains and bodies. It is easier to recognize signs of intoxication, so they may not drink as much as someone with functional tolerance. That may also result in a lower risk of liver damage.

People with functional tolerance, on the other hand, are more likely to overdose on alcohol or get behind the wheel while drunk. These individuals may not recognize when they are too intoxicated for these activities.

Yet, dysfunctional alcoholics can experience the same negative consequences as functioning ones. This is especially true if individuals fail to seek treatment for their AUDs.

Why Do Some People Become High-Functioning Alcoholics?

Some people become high-functioning alcoholics due to a combination of factors. Risk factors include but are not limited to lifestyle choices, genes, and mental health issues.

Experts have found that people drinking early in life are more likely to become functioning alcoholics. These individuals may not develop an AUD at first. Instead, their addiction emerges in adulthood.

Genes may also play a role. Recall that we mentioned how some people achieve functional tolerance due to changes in their livers. These changes may come about due to a genetic predisposition to functional tolerance.

Alcohol is a central nervous system depressant. People with mental health conditions like anxiety may have an overactive central nervous system. They may not experience the effects of alcohol as intensely as someone without anxiety would.

Another reason some people become functional alcoholics is intelligence. People who know their drinking could upend their lives may learn to hide their alcohol use better.

Approximately 20% of alcoholics are high-functioning. These individuals are disproportionately well-educated and with high incomes. Sadly, these individuals make up the largest alcoholic subtype.

Living With a Functional Alcoholic

Many people do not know they are living with an alcoholic. Identifying a loved one’s issue is even more challenging when they are a functional alcoholic. They may not struggle to maintain their job or meet social or familial obligations.

The person may even hide their drinking. Due to functional tolerance, it may be difficult to tell when or even if the person is intoxicated. The only sign may be withdrawal symptoms when the person quits drinking.

Yet, just because the signs are challenging to recognize does not mean they do not exist. Often, one of the most obvious signs that someone is living with a functional alcoholic is co-dependency.

What Does It Mean to Be Co-Dependent With an Alcoholic?

Being co-dependent with an alcoholic means that the other person sacrifices their own needs for those of the alcoholic. Co-dependency can occur in romantic partnerships and parent-child relationships.

Co-dependency from the perspective of a partner may feel like failing to have their needs met. The co-dependent partner may view the alcoholic as incapable of caring for themselves. They may feel they are responsible for the alcoholic’s well-being.

Co-dependent partners may enable the alcoholic’s drinking problem directly or indirectly. They may fail to erect firm boundaries and put their interests first. Or they may frequently offer unsolicited advice to others.

These characteristics can be summed up in four features of co-dependent people:

1. Lack of a sense of self
2. Emotional imbalance
3. Occupational imbalance
4. Fear of abandonment

Children who learn co-dependent behaviours in childhood often develop co-dependent partnerships in adulthood. For that reason, co-dependency from a child’s perspective looks similar to an adult’s experience.

Children with alcoholic parents often experience early childhood traumas. They may be victims of neglect or physical or emotional abuse. Ultimately, these early traumas increase their risk of mental health disorders.

A co-dependent child may enable their parent’s disorder by denying that their alcohol use is an issue. They may make excuses for their parent. Or they may provide financial support to the parent, which allows the parent to continue drinking.

How to Effectively Communicate With a High-functioning Alcoholic?

Communicating effectively with a high-functioning alcoholic requires loved ones to focus on what’s going wrong in the alcoholic’s life. Loved ones should expect excuses from the alcoholic, who will point out everything that is going right.

Learning how to talk to a functioning alcoholic may require persistence. As mentioned, these individuals tend to be well-educated, and high earners. They may have intelligent strategies for convincing loved ones to sweep their alcohol problem under the rug.

In this case, loved ones may need to recruit others. Consider hosting an intervention. The goal is to offer multiple perspectives on the alcoholic’s problematic behaviour.

Many loved ones may believe they do not need to learn how to help a functioning alcoholic. They may believe that because the person has not experienced negative life consequences, their drinking is not hurting anyone.

However, functioning alcoholics are at risk of significant health issues. If they continue drinking excessively and frequently, the alcoholic is at risk for liver damage, brain damage, and more.

Can a High-functioning Alcoholic Become a Social Drinker?

Yes, a high-functioning alcoholic can become a social drinker when they seek treatment for their condition. Even dysfunctional alcoholics can learn to drink in moderation when they get help.

Moderation Management (MM) programmes strive to help recovering alcoholics do just that. MM programmes require alcoholics to abstain from drinking for 30 days. During this time, they learn new coping strategies to replace alcohol use.

The goal of MM is to teach people to drink in moderation. Moderate drinking looks like consuming up to two alcoholic beverages per day. However, this goal is not achievable for everyone.

Specifically, people who struggle to control their drinking may not benefit from MM. These people meet the first criteria for AUDs. They frequently consume more alcohol than intended once they start drinking.

Additionally, people who experience intense withdrawal symptoms may struggle with the abstinence period. This may be more likely in people who experience moderate to severe alcohol withdrawals. These symptoms include delirium tremens, hallucinations, and seizures.

Treatment for Functioning Alcoholics

The good news about functioning alcoholics is that treatment can help. Addiction treatment centres like Simcoe offer detox and inpatient programmes for alcoholics.

Detox allows alcoholics to undergo withdrawal under medical supervision. Many alcoholics can also access medications to ease withdrawal symptoms. They may also be eligible for anti-craving medications after detox.

Treatment programmes vary by individual, but most include individual and group therapy. Group therapy provides support from other recovering alcoholics.

Individual therapy teaches people new coping mechanisms to use in place of drinking. Recovering alcoholics can also learn about the possible reasons why they drink. They can also address untreated mental health conditions that could be exacerbating their AUD.

At Simcoe Addiction and Mental Health, we offer inpatient treatment for alcoholics. Individuals live at our facility while receiving care. That way, they can reside safely away from temptations in the real world.

Do You Need Help for a Drinking Problem in Ontario?

A functional alcoholic may not seem like they have an alcohol problem. However, their problematic drinking still qualifies them for an alcohol use disorder (AUD).

Are you a high-functioning alcoholic in Ontario? Get help now to prevent your AUD from impacting your health and relationships. Learn more about alcohol addiction treatment and enroll in Simcoe’s inpatient programme before it’s too late.