Our cultural vision of an alcoholic is someone who stumbles around, constantly drunk, and whose home life and career are falling apart. If you drink but you still keep your life together, you’re not an alcoholic, right?
Unfortunately, our cultural view of alcoholism isn’t quite accurate.
In reality, a person can have an alcohol use disorder, and even a chemical addiction, and maintain a relatively normal life from an outside perspective. While others may presume that a functioning alcoholic has everything in their lives under control, there are problems beneath that may lead to serious consequences.
Though someone with a good job, a loving family, and a clean bill of health may not seem to have a problem with alcohol, there may be psychological, emotional, and other problems just beneath the surface. In this guide, you will learn about the spectrum of alcohol use disorders and the truth behind the supposed functionality of alcoholism.
Who Qualifies as a Functioning Alcoholic?
From binge drinking to full-blown alcoholism, there is a wide spectrum of problematic alcohol use from which people all over the United States and the world suffer. College students may binge drink every other weekend for a few months, and while they risk accidents, poisoning, and other dangers, they may never develop a chemical addiction to alcohol. On the other hand, those who do develop a chemical addiction may drink at all hours of the day to avoid severe withdrawal symptoms. So where does the high-functioning variety fit in?
Since alcohol use disorders come in a range of cases, doctors are seeking better ways to identify alcoholism. Not every person who abuses alcohol can benefit from the same type of treatment. And, of course, there needs to be a way to diagnose less obvious cases. In order to correct the cultural view of the typical alcoholic, researchers from the National Institutes of Health (NIH) looked at the different types of alcohol use and broke alcohol use disorders into several subtypes including:
- Young Adult – Young people who drink typically have a low rate of co-occurring disorders of family history of alcoholism.
- Young Antisocial – Drinkers in their mid-twenties that have significant rates of co-occurring disorders and family history of alcoholism. A large percentage also smokes cigarettes.
- Functional – Middle-aged drinkers that are typically well-educated with stable jobs and families; a significant portion have a family history of alcoholism and a personal history of depression
- Intermediate Familial – Middle-aged drinkers, half of which have a family history of alcoholism and/or a personal history of depression
- Chronic Severe – These are mostly middle-aged drinkers who began drinking early in life. Chronic severe drinkers have high rates of personality disorders and criminal issues. The vast majority come from a multigenerational family history of alcoholism. Because of its severity, this subtype is the most diagnosed and treated despite it only making up nine percent of alcohol use disorder cases.
The functional subtype is directly in the middle of the spectrum of AUDs both in severity and in prevalence. People with functional alcoholism may have symptoms of physical and/or psychological dependence on alcohol, but they still manage to maintain a career, social, and family responsibilities.
However, alcohol comes with a large arsenal of negative side effects and consequences that can affect anyone who drinks heavily on a regular basis, even if it doesn’t begin to bleed into other areas of your life. Plus, as heavy use continues, your likelihood of developing a more severe dependence on alcohol is increased.
How Alcohol Works in the Brain
Alcohol (or more specifically, ethanol) has profound effects on the brain and body of heavy users. Alcohol is toxic at high amounts and suppresses normal brain activity. In large enough quantities, it can suppress memories, loss of muscle control, slowed breathing, and low heart rate. However, there are two barriers that it has to pass once it enters your body that keep it from going straight to the brain. The liver is great for filtering out trace toxins but it isn’t designed to handle large amounts.
Alcohol and The Liver
First, alcohol makes its way to the liver where it is filtered out of your blood before it gets to the brain. In moderate quantities, your liver can stop toxins like ethanol from ever noticeably affecting you. However, alcohol is potent and it takes less than most people think to exceed your liver’s capabilities. Two drinks within two hours will push past your liver for men and one drink for women.
Alcohol and The Blood-Brain Barrier
The blood-brain barrier is what stops certain substances in your blood from reaching your brain cells. Once alcohol gets past your liver, it has one more barrier to contend with and, unfortunately, it doesn’t put up much of a fight. Alcohol not only slips past the blood-brain barrier, it also is one of the factors in having a weakened blood-brain barrier.
Alcohol in the Brain
Like all psychoactive drugs, alcohol affects your brain by altering neurotransmitters, the chemical messengers that carry signals from one neuron to the next. Some neurotransmitters are excitatory and are responsible for increasing the electrical activity in the brain. Others are inhibitory, which suppress activity. Alcohol affects both inhibitory and excitatory neurons.
There are other causes as well. Genetic and biological factors can affect the way you process alcohol and its addictive hold over you. One notable point that is illustrated by the NIH is the severity of an AUD seems to be related to a family history of alcohol, with chronic severe alcoholism having the highest rate (50 percent) of multigenerational alcoholism.
The Prevalence of High Functioning Alcoholics
With the U.S. currently in the middle of a deadly opioid epidemic, the problem of alcohol is often forgotten. However, it is a significant problem, the size and scope of which may be surprising to many. The vast majority of adult Americans drink. Alcohol is a staple in advertising and many aspects of our culture from prime-time TV to wedding toasts. It’s legal, therefore many assume that it’s safer than other psychoactive substances. This general cultural acceptance and it’s availability contribute to the fact that over 86 percent of people in the U.S. have had a drink. By comparison, marijuana is increasing in cultural acceptance and prevalence but only about 45 percent of Americans have tried it.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), over 15 million adults over the age of 18 met the qualifications for an alcohol use disorder. The largest group in this category are young adults who binge drink, often on college campuses, where drinking in excess is almost a standard rather than an abuse of the substance. This cultural view of drinking excess isn’t limited to young adults.
Alcohol is present in the workplace in many industries. The TV series Mad Men often portrayed the employees of an ad agency in the 1960s as frequent drinkers during office hours. Some character had small dry bars in their offices. This image may seem like a time long past, but it’s a reality in some workplaces. Middle-aged men and women may feel the same pressure to drink as a means to integrate with a group and gain success as a college teen in a fraternity.
The pervasiveness of alcohol in the workplace may contribute to alcoholism among middle-aged professionals. High-functioning alcoholics make up 19.5 percent of all AUD cases in the U.S., making it the third most prevalent subtype.
How to Recognize High-Functioning Alcoholics
Functional alcoholism is, in many ways, a contradiction. There’s a wide range of consequences of alcohol abuse. While a person can maintain outward appearances for a while, maybe even to their own family, your body is just not meant to handle an addiction to a dangerous chemical substance. Plus, alcoholism has a close relationship with other deeper issues like anxiety and depression. The longer you feed alcoholism, the more likely you are to experience social, medical, financial, and emotional consequences.
In some cases, the ability to maintain normalcy may actually hinder a person with an alcohol use disorder from getting the help they need. You might think, “I still make it to work on time every day. I spend time with the family. There’s no way I’m an alcoholic.” Having your life in relative order allows you to entrench yourself in denial. Meanwhile, you may be experiencing blackouts, feeding a chemical dependency, and growing more irritable as withdrawal symptoms begin.
People who abuse alcohol often surround themselves with other people that do the same. Then, you may begin to compare your drinking habits to them. There are a couple of problems with this idea:
- It’s difficult to gauge how much another person is drinking when you are also drinking. You may assume that other people are having as much as you when, in reality, they are staying in or close to their limits.
- You may be measuring yourself by a faulty metric. Your friends and drinking buddies may have an alcohol use disorder as well.
Eventually, consequences will break through the physical, financial, and emotional levels you’ve built. A DUI or legal troubles, relationship issues from withdrawing from social obligations, financial strain due to funding addiction, or medical complications can begin to take their toll. When that happens, consequences can begin to snowball and the insistence that alcoholism is not a problem will continue to make things worse.
Are High-Functioning Alcoholics in Control?
Ostensibly, the high-functioning alcoholic seems to be in control. Maybe you drink a lot after work, but no one has seemed to have serious complaints. You make it to work every day, on time, make decent money, your relationships haven’t suffered, and you’re generally healthy. However, if you dig a little deeper, you aren’t actually the one in control. To maintain an alcohol use disorder, a lot of time is spent buying alcohol, drinking, sobering up, and starting over.
Plus, you may also have to hide the telltale signs of frequent alcohol use from your family and employer. At this point, drinking becomes more like a part-time job than a recreational activity. As a high-functioning alcoholic, you aren’t in control, alcohol is controlling you and constantly threatening to undo other aspects of your life.
Functioning Alcoholic Withdrawal
“Withdrawal symptoms are a telltale sign of alcohol addiction and dependence. Alcohol comes with some of the most dangerous withdrawal symptoms and in some cases, symptoms can be fatal, especially without medical treatment. For a high functioning alcoholic that might be in the early stages of chemical dependence, the symptoms may start subtly. ”
Signs and symptoms of alcohol withdrawal generally occur in the central nervous system. In severe cases, hallucinations, delirium, and seizures can occur. For this reason, if you begin to experience alcohol withdrawal symptoms, it’s important to seek medical assistance immediately.
Symptoms vary based on the amount of alcohol you drink and the length of time you’ve been dependent on alcohol. In the daily life of a high functioning alcoholic, they are likely to experience some of the milder symptoms between drinking sessions. Symptoms can include:
Such symptoms can occur after six hours after your last drink. That means it can start to happen on long flights, early in the morning, and in the second half of the workday. The longer you have been drinking excessively the more likely you are to experience extreme symptoms. However, in some cases, dangerous symptoms can happen in as little as two hours after your last drink.
Signs of Alcoholism in High-Functioning Alcoholics
If you are concerned that you may have an alcohol use disorder, or if loved ones have come to you with these concerns, there are several signs that point to a potential problem with alcohol. If you suspect that a loved one might have an alcohol use disorder, it’s important to know the signs and what you can do to help.
Denial and Resistance
Denial is common among highly-functioning alcoholics and it’s likely that friends and family members who suggest that there is a problem will be rebuffed with, “I am not an alcoholic.” Despite this assertion, people with an alcohol use disorder may also resist suggestions to stop or cut back on alcohol use. It’s also common for them to hide alcohol use and hide alcohol in different places around the house. In order to have it on hand when it’s necessary to sneak a drink, a functional alcoholic may keep bottles in the car, on their person, or in other areas of the house.
Drinking Alone or at Odd Hours
Because withdrawal symptoms begin to happen after six hours, many people with a substance use disorder feel the need to drink in the morning. If you or a loved one is drinking with breakfast, especially before starting the workday, this should definitely set off a red flag. Most people that drink without abuse wait until later hours to have a drink and it’s typically seen as odd in social situations. People who feel compelled to drink in the morning may also try to hide it from other people and family members.
Using Alcohol to Treat Other Issues
Sometimes, the first sign of problematic drinking is using alcohol to overcome emotional issues. It can be subtle, like drinking to overcome social anxiety or it can be more obvious, like when people “drown their sorrows” in alcohol. Depression, in particular, has a close relationship with alcohol (more on that later). Alcohol has relaxing effects that can alleviate emotional issues and even relieve people struggling with mental health issues. However, alcohol will eventually worsen mental disorder, especially depression.
Irritable and Quick to Anger
Some of the side effects of withdrawal include anxiety and irritability. Someone with an AUD is likely to respond to challenges and adversity with frustration and anger. This is especially common when a loved one confronts them about their alcohol use. Angry outbursts or passive aggressive responses are common. Because of the withdrawal symptoms, the embarrassing social stigma of alcoholism, and the nature of addiction, facing alcoholism can be frustrating and painful.
Trouble with Work Performance
Whether a person is a student or an employee or both, it’s impossible to maintain the balance of your daily workload and daily excessive drinking. The effect of an alcohol binge lasts longer than people think. It depends on your tolerance level and the number of drinks you have but the effects of a heavy alcohol binge at night can last well into the next day. If you experience a hangover, you may be foggy for hours. Long after the obvious effects of alcohol have worn off like dizziness and euphoria, you may still have lingering effects suppressing your cognitive abilities.
Alcohol isn’t cheap. Even if your drink of choice is a cheap convenient store brand, the cost of drinking in excess can really add up. Even if you drink a six-pack of beer for $6 every day (which is a very cheap beer and may be relatively a low amount for many people with AUDs) you are spending $2,190 every year to maintain drinking habits. The expense coupled with problems at work can lead to significant financial issues as a result of alcoholism. Compared with the cost of treatment, you are ultimately saving money by addressing your addiction.
Reasons to Quit Drinking
Even if you are able to handle your workload and your family life while juggling an AUD, your body may not be able to keep up for long. You may start to experience:
- Decreased heart rate and breathing.
Auto accidents are another risk to your health that is related to the short-term effects of alcohol. Several of alcohol’s side effects can affect your ability to drive. It can cause dizziness, slower reaction time, slower pupil reaction, and decreases inhibition and the ability to make sound judgments. It also increases your likelihood of experiencing what is called inattentional blindness, which is a psychological lack of attention to certain details that enter your vision. This happens all the time in everyday life in small ways. However, it can increase with alcohol. For instance, if you are merging into another lane, alcohol-induced inattentional blindness can cause you to fail to notice that another car is also merging into your path.
In 2015, 10,265 people died in car accidents where one of the drivers was impaired. Trying to meet the demands of a normal life while trying to manage habitual alcohol use may, at some point, put you behind the wheel of a car while you are under the influence. When that happens, you are not only putting yourself at risk you are putting others at risk as well.
Long-Term Health Risks
Alcohol has been found to have significant links to serious medical conditions after long-term heavy use. In fact, most of the body’s major systems can be affected by long-term alcohol abuse including the central nervous system, cardiovascular system, respiratory system, and even the skeleton can all be negatively affected by long-term alcohol use.
- Heart disease – Excessive alcohol consumption has been linked to an increased risk of heart failure, especially if you’ve had 10 years of heavy alcohol use or more.
- Stroke – Heart complications due to alcohol use can also increase your risk of stroke
- Dementia – Despite reports that moderate use of alcohol can decrease Alzheimer’s risks, long-term excessive alcohol intake has been associated with impaired memory and cognitive abilities leading to dementia.
- Cancer – Alcoholism has been linked to several types of cancer including head and neck cancer, esophageal cancer, liver cancer, breast cancer, and colorectal cancer.
- Liver disease – After years of struggling to filter out alcohol, the liver can become inflamed leading to a disease called alcohol hepatitis, bloating, nausea, vomiting, pain, and loss of appetite.
- Pancreatitis – Alcoholism can also lead to inflammation of the pancreas, causing abdominal pain, bloating, nausea and vomiting.
Drinking Effects in Young Adults
Drinking excessively is especially dangerous for people under 25-years-old. Before your mid-twenties, your brain is still developing. Specifically, it is going through a process called myelination. Myelin is a fatty substance that insulates a nerve cell’s axon (the long fiber on a neuron that conducts electricity and carries it to other neurons). When the axon is covered in a myelin sheath, signals travel faster, improving your cognitive ability. Heavy alcohol use has been shown to stunt or slow myelin growth in the early stages, leading to permanent consequences.
While the majority of functioning alcoholics are middle-aged, this problem concerns them as well. The largest age range for functioning alcoholics is also the age range that is most likely to have children and teenagers. Studies show that the children of alcoholics (COA) are about four times more likely that non-COA children to develop an AUD as well.
Risk Factors of Alcoholism
There are a number of risk factors for alcoholism and examining these causes can give you insight into your own alcohol use. If you drink frequently and heavily and some of these factors are familiar to you, it could indicate an alcohol use disorder. There is no one cause you will be able to point to as the origin of your alcohol problems. However, many of the factors work together to give a person a greater likelihood of developing an AUD.
- Psychology – Psychological issues increase your risk of developing an AUD. Anxiety, depression, post-traumatic stress disorder, bipolar disorder, schizophrenia, and other mental health issues have strong ties to alcohol use disorders.
- Family History – Genetic factors play a huge role in the development of an AUD. Parental alcohol problems correlate with alcohol abuse in children. A family history of multigenerational alcohol use disorders increases your risk of developing an AUD even further.
- Personal History – Your own history with alcohol can affect your alcohol use later in life. Research shows that people who begin using alcohol as teens are more likely to develop and alcohol use disorder later in life.
- Environment – Your exposure to alcohol in your environment also increases your likelihood of developing an alcohol use disorder. If you live next to a liquor store, you’re more likely to drink than someone who has to drive for 30 minutes to buy alcohol.
Still, it’s important to note that even if you identify with every one of these factors, alcoholism isn’t inevitable, and it still can be treated. Many people have several risk factors and never have problems with drinking. Others that do develop an AUD go through treatment and continue on to lead alcohol-free lives. But, the first step is to admit that drinking has become a problem and to seek help.
Getting Help Dealing with Alcoholism
If you or a loved one is struggling with an alcohol use disorder, it can be difficult to get the help you need, not because it isn’t available, but because it can be difficult to admit that alcohol use has a problem when you’ve been able to maintain a facade. However, your health, job, and relationship would be on the line. Plus, alcohol withdrawal can be dangerous and requires medical attention to get past.