High-Functioning Alcoholic: Signs, Risk Factors & Treatment

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A functioning alcoholic is a person who, despite suffering from alcohol abuse, can maintain a relatively well-balanced life.

They have stable careers, participate normally in social activities, and provide proper care for their families.

These people have some sort of control over the amounts they drink and the time they select to consume alcohol.

They don’t disregard what they need to do and prioritize alcohol over everything as a person suffering from alcohol use disorder (AUD) would.

According to the National Institutes of Health (NIH), 20% of alcoholics are highly functional, well-educated, and have stable jobs and good incomes.

Functioning Alcoholism Vs. Alcohol Use Disorder (AUD)

AUD is a clinical diagnosis describing people who have an alcohol abuse issue.

Alcoholism can be divided into five stages, with the first stage being the occasional drinking at parties and gatherings. Other stages are considered within the scope of alcohol use disorder.

On the other hand, a functioning alcoholic is a non-clinical term that describes a person who does have AUD but doesn’t suffer as significantly from it as someone with a fully-blown alcoholism.

Signs of a Functioning Alcoholic

Since high-functioning alcoholics don’t exhibit prominent symptoms of AUD, it can be difficult for the ones they love to sense that something is wrong.

Here are some common signs of high-functioning alcoholism:

  • Lying about drinking and getting into heated arguments if accused.
  • Hiding or stockpiling drinks to prevent repeated visits to the liquor store.
  • Visibly drinking a lot or even binge drinking without appearing intoxicated.
  • Occasionally joking about having a drinking issue.
  • They try to quit more often than not but usually fail.

Even when confronted with their drinking problem, functioning alcoholics may try to rationalize their behavior.

They may come up with excuses like “Drinking isn’t affecting my life or family” or “I pay my dues, and everyone drinks anyway.”

How Does a Person Become a Functioning Alcoholic?

People who drink exhibit drinking signs and symptoms at varying degrees depending on their tolerance and the amount of alcohol consumed.

Yet, some people manage to function well even when drinking heavily; here’s how:

1. Tolerance

Over long periods of drinking, your body develops metabolic and functional tolerance.

Increased Alcohol Breakdown (Metabolic Tolerance)

When you drink, your liver produces various enzymes, primarily alcohol dehydrogenase (ADH), to metabolize the alcohol you consume and break it down into harmless byproducts.

As you drink for more extended periods, your liver starts to adapt by secreting more ADH per drinking session, allowing your body to process alcohol faster.

This reduces the effect of alcohol on your body, requiring more drinking to achieve the previous calming and pleasing effects associated with drinking.

Nervous System Adaptation (Functional Tolerance)

Normally, brain cells communicate with each other using neurotransmitters. Among the major neurotransmitters is gamma-aminobutyric acid (GABA). Once GABA binds to its receptors in the brain, it creates a calming effect.

Alcohol disrupts this communication by mimicking GABA, flooding the GABA receptors, and causing excessive calming effects that people desire from drinking.

This excessive effect isn’t the body’s norm, and it tries to restore its equilibrium by producing less GABA and downregulating the number of GABA receptors.

The brain may also upregulate the activity of other types of neurotransmitters that have an exciting effect, like glutamate, to counteract that excessive calming effect.

2. Strategic Drinking

Functioning alcoholics crave alcohol just like non-functioning ones, but they schedule their drinking around important commitments.

For example, they can limit drinking during workdays or before social gatherings but drink heavily when they perceive less risk of immediate consequences.

3. Favorable Circumstances

A person with AUD may have a supportive local circle, which, ironically, can unintentionally enable the behavior.

Supportive friends or family members who are unaware of the problem and don’t show concern may create the illusion that “everything is going well and there’s no need to quit.”

Another example is when they have a demanding career, as it provides structure and a sense of purpose, allowing the alcoholic to focus on work achievements while compartmentalizing their drinking life.  

Risk Factors of Functioning Alcoholic Behavior

Having an AUD without exhibiting obvious physical and mental symptoms may not seem dangerous at first, but it’s not a sustainable situation. Here’s why:

Increased Risk of Binge Drinking

A functioning alcoholic who gets deprived of alcohol because of work or family may come back hard at alcohol consumption in the form of binge drinking.

Alcohol Poisoning

Developing alcohol tolerance can seem like a good thing but may contribute to a life-threatening situation.

When a person with high tolerance fails to get the desired effect of drinking, they may keep drinking until they develop alcohol poisoning.

Liver Disease

When the liver is forced to process alcohol every day, multiple metabolism processes will be disrupted. This is initially reversible and can be fixed if the person stops drinking.

However, insisting on drinking can make their condition deteriorate from fatty liver disease, to alcoholic hepatitis, and lastly, to cirrhosis, which is irreversible.

Memory Loss

Alcohol may cause short-term memory blackouts when it affects the nerve communication in the hippocampus, a brain region necessary for forming new memories.

Long-term drinking not only disrupts nerve communication in the hippocampus but also causes nerve damage, which can lead to permanent memory issues.

Alcohol can also interfere with Vitamin B1 absorption when it damages the lining of the intestine, which is necessary for brain function. Deficiency in Vitamin B1 can contribute to memory loss and a condition named Wernicke-Korsakoff Syndrome, also known as alcoholic dementia.

Weakened Immune System

Multiple, seemingly paradoxical interactions between excessive drinking and the immune system lead to disruption in an individual’s immunity, according to NIH.

Alcohol can cause gut disruption, which weakens the blood-gut barrier, making it easier for harmful pathogens to enter the bloodstream.

It also causes low-grade inflammatory responses in various parts of the body. Inflammation may be a normal part of an immunologic response, but chronic inflammation can inhibit the immune system’s ability to function properly due to high levels of cortisol, a natural immunosuppressant.

How a Functioning Alcoholic Is Treated

Treating a functioning alcoholic is similar to treating a non-functioning one, but there’s an extra initial step.

Functioning alcoholics are often in denial because they can maintain their lives. They’re unable to understand how unsustainable their condition is, nor the physical (and potentially mental) side effects they are developing.

You need to make the person you care for understand that their current composure is temporary and that alcohol addiction is closer than they think.

Since functioning alcoholics have more mental composure than non-functioning ones, they may be more likely to listen. Once they do, they can receive treatment through:

Alcohol Addiction Treatment Centers

Treatment centers help overcome alcohol dependence by providing inpatient and outpatient alcohol detoxification services, which are often followed by behavioral and mental rehabilitation. This is to handle whatever caused the alcoholism to begin with.

These centers differ in how they handle the treatment process to provide a more approachable treatment method for different people.

Telehealth Services

Telehealth services can be a better choice for functioning alcoholics, as they don’t have to halt their work life to get treatment within addiction treatment centers.

These services offer treatment through remote communication, including video conferencing, phone calls, and secure messaging apps.

The treatment provided is conducted by certified professionals, and the methods utilized are evidence-based. They can provide electronic prescriptions and send them to the pharmacy you need for you to pick up.

Additionally, they are available online, which is excellent for those who frequently travel, as they only need a working connection.  

Support Groups

Support groups are available through the two treatment methods above, but they can also be utilized independently. Support groups are primarily for mental support and anonymity.

Many support communities like Alcoholics Anonymous have multiple meeting locations across the United States. They also have online meetings for those who prefer group therapy from the comfort of their homes.

Frequently Asked Questions

Do Functioning Alcoholics Get Alcohol Withdrawal Effects?

Yes, functioning alcoholics, despite having a higher alcohol tolerance, get the same withdrawal effects that non-functioning alcoholics do.

Can Functioning Alcoholics Reduce Their High Tolerance?

Yes, a functioning alcoholic may reduce their alcohol tolerance by not drinking for a period of time. However, care should be taken if they drink again, as their bodies won’t safely handle the same amounts they’re used to drinking.

Can Functioning Alcoholics Quit on Their Own?

Yes, both functioning and non-functioning alcoholics can quit on their own. According to a 1996 study, around 77.5% of alcoholics who had an alcohol problem for over a year quit drinking without help or treatment.

Prevent the Negative Effects of Alcohol Abuse Today…

Despite not suffering from it, a functional alcoholic is still subject to negative consequences of their drinking habits and may lose control at one point.

If you or someone you love suffers from alcohol use disorders or other forms of substance abuse, be sure to book an appointment with CuredNation to have a trained professional assess your condition from the comfort of your home.  

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