By Marvin Roe on April 18, 2023 || Category: Sober living
You may hear them called “functional” or “high-functioning” alcoholics. But those aren’t official medical terms. To cope with your stress, you may want to attend a support group for family and friends of people with alcohol use disorder (such as Al-Anon) or consider therapy. For the functional alcoholic, the denial runs deep, because they have yet to encounter significant negative consequences. People who live fully functional lives can still have AUD and can benefit from treatment and support.
Sometimes, people with alcohol use disorder don’t recognize their drinking is an issue, especially if they meet their work and home life responsibilities despite their alcohol dependence. As such, they may justify their drinking as a normal part of life—even though it isn’t. “Functioning alcoholic” is an outdated term that in the past was used to describe people with alcohol use disorder who appear to meet their everyday responsibilities. However, alcohol use disorder is diagnosed based on a set of criteria that aren’t always seen by others. The most in-depth care allows you to live full time at a treatment facility.
A doctor may also diagnose AUD by asking about your health history and drinking patterns. If you give permission, they may speak to your family or loved ones crack addiction signs and symptoms of crack cocaine use regarding how much you drink. Support from other people who struggle with alcohol use disorder is an integral part of recovery, alongside medical treatment.
For this reason, it is hard to determine exactly how many people might have high-functioning AUD. However, there are individuals that meet the criteria for AUD but do not experience these impacts. The classic picture of someone with alcohol use disorder is someone who always drinks too much and whose life is falling apart because of it. By Sarah Bence, OTR/LSarah Bence, OTR/L, is an occupational therapist and freelance writer. She specializes in a variety of health topics including mental health, dementia, celiac disease, and endometriosis.
Although you may still hear people talking about “alcoholism” or “alcohol abuse,” the official term is alcohol use disorder (AUD). And it’s all still problem drinking, even if you think it’s “mild.” If AUD goes unrecognized and untreated, it’s linked to risks in many aspects of your health and life. “Functioning” is subjective and limiting when describing a person living with alcohol use disorder. Certain factors may increase your risk of developing an alcohol problem. Binge drinking, social pressures, family history, mental health issues, and excess alcohol use can all increase your risk of developing an alcohol use disorder.
Therefore, they continue to drink to keep the withdrawals at bay, and the cycle continues. Drinking rarely causes them to miss work and other obligations (although it does happen occasionally). They are usually able to manage areas of life including jobs, homes, and families. 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.
A “drug metabolism drugs” (or “high-functioning alcoholic”) isn’t a formal medical diagnosis, but a term used colloquially to describe a person who is dependent upon alcohol but can still function in society. The term “currently-functioning” may be used since it’s not likely they will remain functional (and not misuse alcohol) indefinitely. Unfortunately, even when functional alcoholics begin to recognize that they have a drinking problem, they still resist reaching out for help. By the time they admit the problem, their withdrawal symptoms—which can begin within a few hours after their last drink—can become more and more severe.
Media portrayal of people with alcohol use disorder is often stereotypical and does not accurately reflect the complexity of alcoholism as a disease. In this article, learn more about why the term “functioning alcoholic” is outdated and the impact of living with untreated alcohol use disorder. While the term “alcoholic” was used in the past but is now viewed as outdated and stigmatizing. Today, healthcare professionals would say that a person has an alcohol use disorder (AUD). 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. Some people seem to be just fine even though they misuse alcohol.
They may take steps to avoid the person while they are drinking, or they may experience feelings of guilt, shame, or self-blame. Chronic heavy drinkers can display a functional tolerance to the point they show few obvious signs of intoxication even at high blood alcohol concentrations, which in others alcoholism and anger management would be incapacitating. Both residential and outpatient day treatment programs are available for those in recovery. It can also ultimately lead to relationship difficulties as well as legal and financial problems. There are no official diagnostic criteria for what it means to be high functioning.
If needed, your doctor may also order blood tests to check your liver function. Although you might not hit all the criteria for the condition, and the impact on your life may appear minimal, AUD is a chronic and progressive condition. This means the negative impact on your life will likely grow, and the condition will not get better on its own without treatment. 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. If you think that you or someone you know may be drinking too much, ask your doctor about getting help – whether it’s from a therapist, psychiatrist, or other addiction specialist. Organizations such as the American Society of Addiction Medicine can guide you to help, too.
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. 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.
Instead, the DSM-5 has established AUD as the term to replace previous stigmatizing terms such as alcohol dependence, alcohol abuse, and alcoholism. 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. One sign that someone may have alcohol use disorder is that they consume excessive amounts of alcohol. This can look like binge drinking (drinking a lot over a short period) or heavy drinking (drinking a lot over a more extended period). Below are some signs that you or someone you love may be living with alcohol use disorder. These signs don’t always affect a person’s ability to carry out their day-to-day responsibilities.
Being able to carry out regular responsibilities with AUD is not the same as being free of the disease. Alcohol use disorder can still have a significant impact on a person’s life, even if they appear to be coping from the outside. The refusal to abstain can become more apparent in certain situations. This includes times when many people give up alcohol, such as “dry January” or the period of fasting and penitence in the Christian calendar leading up to Easter known as Lent.
Someone can live with alcohol use disorder without anyone else noticing. However, they are likely struggling with uncontrollable cravings, unsuccessful attempts at quitting, and obsessive thoughts about their next drink—all hallmarks of an alcohol use disorder. 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. 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.
It may also cause an individual to refuse to travel to areas where alcohol access may be limited. Someone with alcohol use disorder may struggle to cut back on drinking or quit, either when trying to do so themselves or when asked by others to try. These criteria are often internal struggles, not observable to others.
John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). For some people, AUD may also mean more than physical dependence, but a stress reliever or source of psychological escape.
