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CCFA’s Guide on the Challenges Faced by Functioning Alcoholics
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CCFA’s Guide on the Challenges Faced by Functioning Alcoholics

Written by Seth Fletcher on January 9, 2024
Medically reviewed by Dr. Chintan Shah
Last update: February 29, 2024

Alcoholism is a term commonly used to describe alcohol abuse and dependence. The alcoholic is preoccupied with drinking, struggles to control their drinking, and often has to face severe consequences due to uncontrolled alcohol use. This condition is clinically known as alcohol use disorder (AUD) and is characterized by the inability to stop using alcohol despite adverse consequences. 

Alcohol use disorder can range from mild to severe, causing significant problems with work, relationships, finances, and virtually all aspects of daily living. Alcoholics experience job loss, divorces, broken relationships, and legal troubles. 

However, some people with alcohol use disorder seem to have no issues. These alcohol abusers are adept at concealing their problems and may be in denial themselves. They display little to no alcoholic personality traits and can appear normal and sober, seemingly able to function in society while achieving great success. CCFA explains what you need to know about functioning alcoholics, the signs, their traits, and the challenges they face.

Key Takeaways

  • Functioning alcoholics can carry out their daily activities and remain productive while showing signs of alcohol use disorder.
  • They are masters of denial and will convince themselves and others that their drinking is not a problem.
  • Functioning alcoholics require professional help to prevent the progression of alcohol use and the development of physical and mental health consequences.

What is a Functioning Alcoholic?

“Functioning alcoholic” or “high-functioning alcoholic” are colloquial terms used to describe individuals able to carry out their daily activities while showing signs of alcoholism. They may appear productive and even thrive in their careers, relationships, and day-to-day obligations without exhibiting the full range of symptoms associated with AUD. Functioning alcoholics have AUD, but their condition does not lead to a breakdown of their family, professional, or social life.

A functioning alcoholic may not be viewed by their loved ones or society as alcoholics, even though they may drink heavily daily or pass out after a session of drinking. They don’t exhibit the stereotypical traits of an alcoholic and so may not be confronted by their friends or loved ones or consider getting help for themselves. 

The adverse effects of alcoholism may not be readily apparent in a high-functioning alcoholic. However, there is often always an area of their lives that is being adversely affected by their drug use. For example, internal organ damage may continue unnoticed until it’s too late. There may also be a gradual deterioration of their relationships till they become unsalvageable. 

Thus, high-functioning alcoholism is as dangerous as or even more so than classic AUD since it takes longer for the severe consequences of alcohol abuse to arise. Alcohol abuse is progressive, and leaving it untreated leads to the buildup of tolerance and extensive damage over time.

It’s crucial to seek help immediately if you think you or a loved one is struggling with high-functioning alcoholism. The Canadian Centre for Addictions offers quality alcohol abuse and addiction treatment. Our team of addiction experts is always ready to assess your situation and guide you towards lasting recovery.

Mental Illness and the Functioning Alcoholic

There is a strong relationship between mental illness and alcoholism. People with mental health conditions like anxiety and depression may turn to alcohol for temporary relief. The National Institute on Drug Abuse (NIDA) reports that as many as one-third of alcohol abusers suffer from a mental health condition, and approximately one-quarter have suffered from a major depressive illness at some point in their lives.

Often, the mental illness is undiagnosed, and the functioning alcoholic is unaware they may be self-medicating with alcohol. Their family members and others close to them may also likely not know. The functional alcoholic will continue to engage in abusive drinking to manage their symptoms as long as the underlying or related cause of addiction remains untreated. 

Mental illness and alcoholism should be treated simultaneously whenever they occur together. Treatment modalities for both conditions generally include detox, counselling, medications, and support.

Recognizing the Signs of a Functioning Alcoholic

Functioning alcoholics are usually skillful at concealing or pretending about their alcohol use disorder (AUD). They may joke about drinking or talk about how well their career or relationships are going. One may know how to spot an alcoholic face, but the absence of alcoholic traits can make a functioning alcoholic seem alright to others. However, there are functional alcoholic signs to watch out for if you think someone is struggling with a drinking problem:

  • Excessive or Heavy Drinking

Functional alcoholics will drink excessively whenever they can and may skip meals to drink. For men, excessive drinking is more than four drinks on a single occasion or 14 to 15 drinks per week. For women, excessive drinking is more than three drinks on a single occasion or seven to eight per week. Functional alcoholics may also use regular mealtimes as an excuse to drink. 

  • Significant Behavioural Changes While or After Drinking

High-functioning alcoholics will often exhibit significant behavioural changes whenever they drink. You may observe a quiet, calm individual suddenly become brash and outspoken while drinking.

  • Experiencing Frequent Blackouts

Frequent blackouts are one of the most common functional alcoholic symptoms. Functioning alcoholics may often participate in activities they struggle to recall the day after drinking. They may do drugs, have sex, go home with strangers, or get into fights and remember little or nothing about the incident when asked. 

  • Trying to Justify Their Drinking

Functioning alcoholics will usually often have an excuse for their excessive drinking. They may cite work stress, family issues, or social obligations as reasons for drinking or claim they drink expensive alcohol as proof they don’t have a drinking problem. They may also get aggressive or defensive when confronted about their alcohol use.

  • Hiding Their Drinking

Functional alcoholics may hide their drinks in their office, car, closet or anywhere that enables them to drink secretly. They may drink before going out to work or sneak to a bar to drink alone. Their secretive drinking behaviour may be due to shame or fear of judgment from others. 

  • Trying and Failing to Quit Drinking

Some functional alcoholics may be aware of their problems and attempt to stop drinking. However, they’ll often fail in their attempts and find themselves returning to drinking after a while. They’ll usually be stuck in a cycle where they abstain from drinking for a time before commencing a period of heavy drinking again. Being trapped in this cycle may not be enough to persuade a functional alcoholic to seek help as they often always think they have things under control.

  • Increased Alcohol Tolerance

Functioning alcoholics may find that they need to drink more alcohol to get the same effects with time. Alcohol tolerance is usually a slippery slope that can lead to dependence and manifestation of the regular characteristics of an alcoholic. 

  • Separating Their Lives Into Sections

Functional alcoholics may separate their drinking from other aspects of their work. Their personality at home or work may be markedly different from who they are when they start drinking. 

  • Feeling Guilt and Shame After Drinking

High-functioning alcoholics who have worked long and hard to create a life and reputation may feel remorseful, ashamed, and guilty after bouts of drinking. The inconsistency of their behaviour with the life they’ve built may prompt them to work harder towards quitting alcohol. 

  • Using Alcohol as a Coping Mechanism

Functional alcoholics may use alcohol as a coping mechanism for stress, anxiety, depression, and other mental or emotional issues. 

  • Experiencing Alcohol Withdrawal 

Functional alcoholics may become restless and irritable if they have to go for an extended period without alcohol. They may also experience other withdrawal symptoms like tremors, headaches, nausea, and insomnia.

Functioning Alcoholics – Masters of Denial

The ability to ignore and mask all of the evidence of alcoholism and to deny that there is any problem is the most defining characteristic of a functional alcoholic. It is also what puts the individual at so much risk. They fail to realize the impact of their drinking on those around them, and because everything appears to be in control, they convince themselves there are no issues. 

As they are skillful at creating the illusion of being healthy and stable, they are usually not the only ones in denial. Their loved ones and friends often don’t see the warning signs or refuse to believe their loved one has a problem. They may even congratulate them on their ability to function while under the influence of alcohol. 

Denial is also problematic because it facilitates tolerance and a deeper dependency. Light or moderate drinking regularly will lead to tolerance buildup in almost any user. They will consequently need to consume more alcohol to achieve the previous level of intoxication. Social drinkers may occasionally overindulge, but they typically appreciate the ill effects and do not repeat the behaviour.

However, if the cycle of abusive drinking continues, the individual will develop a dependency. When this occurs, overindulgence becomes regular, and there may be no ill effects, further intensifying denial. Because the functional alcoholic has developed tolerance to large amounts of alcohol, they’re able to manage all aspects of daily living, reinforcing the idea that there’s nothing to worry about. Unfortunately, this notion puts the individual at risk of severe and possibly fatal alcohol use-related consequences.

Why Is Intervention Important 

Intervention is important as it helps prevent further progression of heavy alcohol use and its consequences. It is also essential to provide early intervention to avoid irreversible organ damage and other related physical and mental health complications. In most cases, willpower will not be enough, and only professional intervention will be able to help a functional alcoholic quit drinking. 

Treatment interventions start with a diagnosis of AUD and possibly co-existing disorders. Interventions may include behavioural therapy, medications, and support designed to help the individual manage their urges and cope with triggers. 

Getting Help

Because denial is such an issue with substance abuse disorders, figuring out how to help an alcoholic, especially a functioning one, can be daunting. It is usually challenging to get them to admit they have a problem, and this is often an impediment to getting help. As a result, the disease may progress for years, leading to complications and an increased risk of death.

A functional alcoholic must be willing to admit that they have a problem and ready to change. It is challenging to get an unwilling functional alcoholic into getting treatment. In some cases, the individual’s support system might unwittingly enable the addictive behaviour. Loved ones may help to conceal the drinking or protect them from the fallout of their actions while intoxicated. This approach, while well-intentioned, may keep the functional alcoholic under the illusion that all is well. 

It’s often necessary to allow the individual to face the full repercussions of their behaviour, as hitting “rock bottom” is often the only way to break the cycle of drinking and alcoholic behaviour. 

Loved ones and friends can also plan and stage a personal intervention for the functional alcoholic. It’s crucial to plan this carefully, soliciting assistance from healthcare experts and choosing the right time and place to initiate the intervention. Members of the intervention team must be honest with the person, providing them with specific examples of how they’ve been affected by their drinking. 

Intervention participants may also need to issue ultimatums to the individual, detailing steps to be taken if the individual is unwilling to curb their drinking and seek help. Providing specifics about what will happen in terms of the relationships with family and friends is crucial. It may mean ending a friendship, cutting off contact, or initiating a divorce. Everyone must be prepared to follow through, or else they’ll be enabling the individual.

The functioning alcoholic should be given time to consider the full impact of what is being said while reinforcing the message that there are consequences associated with choosing not to start addiction recovery in some form.

Treatment Options for Functioning Alcoholics

There are several treatment options for functioning alcoholics, depending on their specific needs and how long they’ve been using alcohol. Treatment options include detox, rehab, therapy/counselling, and support. 

Alcohol detox is a medical process that helps to get all traces of alcohol out of the system. Quitting heavy alcohol use cold-turkey can lead to highly unpleasant and potentially life-threatening withdrawal symptoms. Medical detox allows recovering alcoholics to manage alcohol withdrawal symptoms in a safe environment. Healthcare professionals may administer medications in some cases to manage some symptoms of withdrawal.

Rehab is a program designed to meet the specific needs of the functional alcoholic. A comprehensive alcohol addiction treatment plan may include group therapy, individual or family counselling, support groups, and medications. The level of dependency, the length of time abusing alcohol, and family and medical history all determine the most effective treatment for the individual. If there’s a robust support system in place, an outpatient rehab program that involves attending counselling, therapy and educational sessions while continuing to live at home may be appropriate. 

Alternatively, a more intensive program at an inpatient rehab centre may be indicated for others. In addition to the services provided to outpatients, these facilities may be better equipped to manage more severe detoxification, and they can give a break from the stresses of everyday life. They also offer the emotional support that may be lacking from family and friends. 

Therapy is designed to help patients find the underlying causes of their addictions and to identify their triggers so they can begin to develop better coping strategies, increasing their chances of avoiding a relapse. Support involves 12-step programs, like Alcoholics Anonymous (AA), that provide a warm, welcoming, non-judgmental environment and a self-help approach to recovery. For many functional alcoholics, AA or similar organizations may be an excellent complement to therapy, particularly as part of their aftercare plan.

When to Seek Professional Help

Functional alcoholics will pretend all is well for as long as they can conceal their drinking or remain productive. However, seeing any of the following signs indicates that you may need to seek professional help:

  • Trying and failing to stop drinking
  • Drinking more alcohol than intended
  • Having intense cravings to drink or feeling irritable without alcohol
  • Spending a great deal of time drinking even while remaining functional
  • The effects of alcohol use are beginning to affect your productivity and relationship 
  • Experiencing frequent blackouts after a drinking bout
  • Developing alcohol tolerance
  • Experiencing withdrawal symptoms when you abruptly stop or reduce alcohol use

Conclusion

People with substance abuse disorders will make excuses to justify any behaviour, and the functioning alcoholic is quite skilled at this. The first step toward recovery for these individuals is for their friends and family to hold them accountable for their actions. Otherwise, there is no reason for them to change. 

High-functioning alcoholics have convinced themselves that their lives and loved ones are unaffected by their drinking. However, no matter how masterful they are at concealing their addiction, the illusion will be shattered eventually, and the toll on their health, relationships, finances, or careers will be undeniable.

It is difficult to watch someone you love struggle with a drinking problem, but there are resources to help them recover. If you or a loved one is exhibiting the signs of a functioning alcoholic, the Canadian Centre for Addictions can help. CCFA helps people understand their addictions and the healthier coping strategies available by engaging them in one-on-one counselling with certified counsellors, psychiatrists, and mental health professionals. Call us today at 1-855-499-9446, and someone will speak to you about our services. 

FAQ

What is the difference between a habitual drinker and an alcoholic?

A habitual drinker is someone who drinks alcohol regularly but is not necessarily addicted to alcohol. They may drink more than the recommended amount of alcohol, but they can stop drinking if they want. Alcoholics, however, are addicted to alcohol and will keep drinking despite the negative impacts on their health and well-being. They are unable to quit drinking without help.

Do most alcoholics have personality disorders?

No. Not all alcoholics have personality disorders, but there is a link between alcoholism and personality disorders. Studies have shown that the prevalence of personality disorders in alcoholism ranges from as low as 22% – 40% to as high as 58% – 78%. Some personality disorders associated with alcoholism include borderline personality disorder and antisocial personality disorder.

What vitamin deficiency do alcoholics have?

Alcoholics tend to have a deficiency of thiamine (Vitamin B1), an essential vitamin for energy metabolism and brain function. Alcohol interferes with thiamine absorption and causes a deficiency. Alcoholics may also be deficient in Vitamins B3, B6, B12, folate, and iron. These deficiencies can cause several health problems, including anaemia, fatigue, and impaired brain function.

How many drinks a week will damage your liver?

The number of drinks a week that will damage the liver varies from person to person. However, excessive alcohol consumption, defined as more than 14 to 15 drinks per week for men and more than eight drinks per week for women, can be damaging to the liver.

Why do we give folic acid to alcoholics?

Alcohol consumption is associated with a folic acid deficiency, which can lead to anaemia, lethargy, and confusion. Folic acid is given to alcoholics to replenish the body’s folate levels, improve liver function, and reduce the risk of alcohol-related conditions like cardiovascular disease and certain cancers.

Certified Addiction Counsellor

Seth brings many years of professional experience working the front lines of addiction in both the government and privatized sectors.

Dr. Chintan is a Board Certified Family Physician with an interest in holistic and preventative care as well as healthcare systems. Credentialed Physician with both American & Canadian Board of Family Medicine. Adjunct Professor in the Department of Family Medicine at the Schulich School of Medicine & Dentistry. Telemedicine clinician.

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