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Spotting a Functioning Alcoholic: What to Look For

A common misconception regarding substance abuse and substance use disorders is the notion that an individual can be a “high-functioning addict,” a “functional alcoholic” or some other contradiction of terms. Any individual who has an alcohol use disorder (the current clinical designation for individuals who abuse alcohol and have consequences as a result of that abuse) is displaying some form of dysfunctional behavior. These types of disorders are associated with significant dysfunction and impairment by their very definition. These misconceptions of “functional addicts” are fueled by stereotypes that portray all addicts as being “skid row types” and by popular books, such as Understanding the High-Functioning Alcoholic.

Certain individuals may be able to function in a manner that allows their impairments to generally go unnoticed by others in the same way that those with depression may only keep their serious emotional stress to themselves. Even so, anyone who has a substance use disorder, such as an alcohol use disorder (alcoholism), is not functioning in accordance with their full potential.

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Definitions of Addiction

A quick review of the formal definitions for addictive disorders, as supplied by the major organizations that have defined and identified these conditions, will indicate that anyone who qualifies for a formal diagnosis of a substance use disorder suffers some form of functional impairment.

1. APA  2. ASAM  3. SAMHSA and NIH

  • APA: The American Psychiatric Association sets the standards for the diagnostic criteria that are associated with psychological/psychiatric disorders in the US despite controversies surrounding how these diagnostic categories are developed. According to APA, substance use disorders are mental health disorders that:
  • Lead to significant disturbances in the individual’s emotional regulation
  • Lead to significant disturbances in an individual’s thinking abilities
  • Lead to significant disturbances in an individual’s behavior
  • Results in significant distress or dysfunction in the person’s social or occupational functioning
  • Reflects dysfunctions in the individual’s biological, developmental, or psychological processes.

The terms alcoholism or alcoholic are outdated classifications that are still used by lay individuals and some organizations.
Instead, the term alcohol use disorder has replaced these other terms. Nonetheless, any individual who would be formally diagnosed as being an “alcoholic” or with an alcohol use disorder by definition suffers from serious impairment and dysfunction. Some people are still able to present the appearance that they are coping with their issues or able to fully function in major areas of life.
There are several misconceptions that many people still believe regarding individuals who have substance use disorders.These misconceptions follow:

  • People who are functional alcoholics really do not have a problem. As seen above by the formal definitions of addictive behaviors, any individual who meets the diagnostic criteria for a substance use disorder has a problem.
  • People who are high-functioning alcoholics do not display the signs of alcoholism. By definition, any individual with an alcohol use disorder (alcoholism) must display signs of the disorder.
  • People who are functional alcoholics are in control of their alcoholism. Again, by definition, an individual who has an alcohol use disorder (alcoholism) displays issues with controlling their use of alcohol.
  • People who are high-functioning alcoholics do not need help. By definition, anyone with any form of mental illness/psychological disorder needs help.
  • All people who are heavy drinkers are alcoholics. This is not true. Individuals who are heavy drinkers are more prone to developing alcohol use disorders than individuals who do not drink heavily; however, there is no formal designated amount of alcohol use that can be used to diagnose anyone with an alcohol use disorder. Instead, the diagnosis is based on a number of specific behavioral signs and the effects of one’s alcohol use on their life. There are no quantifiable amounts of abuse that can be used to diagnose any individual with any type of substance use disorder.
How to Look For Functioning Alcoholism

Because no two individuals with a substance use disorder are alike, some individuals with alcohol use disorders may function better than other individuals with alcohol use disorders; however, having an alcohol use disorder by definition requires that one’s use of alcohol is dysfunctional and leads to impairment in their functioning. The degree of impairment is not the same for everyone, but everyone with a substance use disorder could function significantly better without using their substance of choice.

Trying to ascertain whether one is a so-called “functional alcoholic” is a difficult task because again by definition, individuals with alcohol use disorders are often unable to objectively understand the consequences of their alcohol use. Many of these individuals are relatively successful in their work, have families, and do not suffer significant legal issues associated with their alcohol use.

However, if a person honestly answers “yes” to two or more of the following statements, they are very likely suffering from a substance use disorder:

  • Do I have a specific routine regarding my use of alcohol? This can include only drinking at specific times or places, but in those instances, you are almost always drinking alcohol.
  • Has my use of alcohol ever resulted in missing work or school?
  • Has my use of alcohol ever resulted in an argument with a family member?
  • Have I ever attempted to cover up my use of alcohol (e.g., calling into work sick because I am suffering from a hangover)?
  • Have I lost any friends or lost contact with any family members as a result of my alcohol use?
  • Has any family member or friend ever mentioned that I drink too much alcohol?
  • Have I ever asked a family member or friend to cover up for me regarding my alcohol use (e.g., having them call into work to report that I am ill when I am hungover)?
  • Have I ever tried to cut down on my drinking?
  • Do I drink alcohol to relax or feel more confident?
  • Do I ever get angry when someone mentions my use of alcohol or tells me that I drink too much?
  • Have I ever felt guilty about my use of alcohol?
  • Have I ever forgotten what I did while drinking?
  • Have I suffered any legal issues associated with alcohol use?
  • Have I suffered any financial issues associated with alcohol use?
  • Even though I do drink alcohol, have I ever denied drinking alcohol to someone?
  • Have I ever engaged in risky behaviors as a result of my use of alcohol (e.g., driving under the influence of alcohol, using machinery, caring for small children, etc.)?

Any individual who answers “yes” to two or more of these questions should consider consulting with a licensed mental health worker who specializes in substance use disorders and addiction to better understand if their use of alcohol is dysfunctional.

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General Features of Functioning Alcoholics

Individuals who are often defined as being functional alcoholics share a number of different features. They are often:

  • College-educated
  • Employed with fairly decent incomes
  • Married or partnered
  • Attempting to control their use of alcohol by restricting their drinking habits to specific instances or times, such as only drinking after work, having a set drinking routine, etc.
  • Good at convincing others that they are in control of their alcohol use and can convince people close to them to cover up for them when they do have slips
  • Convinced that their behavior is “normal for them” and good at convincing people close to them that their alcohol use is normal
  • Prone to drinking alone
  • Dealing with some other emotional issues, such as depression, an issue with anxiety, low self-esteem, issues with anger, etc.
Identification and Treatment Issues

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First, it should be clear that nearly any individual who would be diagnosed as a functional alcoholic would most likely not seek treatment for their alcohol usewithout some external motivation. This external motivation will often come from an individual’s supervisors at work, family members or friends, or the legal system. Very often, these individuals are involved in performance issues at their job that are related to alcohol use, have other issues like depression, or are forced into treatment by the legal system as a result of some infraction that is related to their alcohol use, such as driving under the influence of alcohol or getting into fights while intoxicated. In these instances, a professional mental health clinician often identifies their substance use disorder through the assessment process, and there is often a significant amount of energy required to convince the person that they have a problem.

It is important to realize that individuals with substance use disorders often require intensive and ongoing treatment to help them develop and maintain a program of recovery. These disorders simply do not go away without some type of formal intervention.

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