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High-Functioning Alcoholism: Understanding the Condition and Treatment Options

High-Functioning Alcoholism: Understanding the Condition and Treatment Options

People with high-functioning alcohol use disorder are able to maintain a stable home and work life and have less noticeable symptoms of AUD.

Just because a person may seem to have their life together doesn't mean there may not be a drinking problem behind the scenes. High-functioning alcohol use disorder (AUD) can be more difficult to detect since people with this condition can often manage their daily responsibilities. Learning the signs of high-functioning alcohol use disorder can help you know when you or someone in your life needs help to prevent their drinking from getting out of control.

Left untreated, high-functioning AUD can develop into an alcohol use disorder that starts to disrupt your personal or professional life. Getting help allows you to regain control of your alcohol consumption before it worsens. Confidant Health's online medication-assisted treatment for alcohol use offers discreet AUD treatment from the comfort of home. Simply download our app to access virtual medication-assisted treatment from our highly skilled team of professionals.

Understanding High-Functioning Alcohol Use Disorder

Alcohol use disorder is a chronic disease in which a person cannot moderate their alcohol consumption despite its consequences on their life. High-functioning alcohol use disorder is similar but with one key difference. When a person with AUD is highly functional, alcohol misuse doesn't appear to adversely affect their life. On the outside, they may seem to have a successful career and happy relationships. When alcohol doesn't interfere with a person's life, they or others may not think there is a drinking problem present. However, there is still a risk of alcohol misuse eventually worsening, leading to a more severe alcohol use disorder. 

Who Is at Risk of High-Functioning AUD?

Approximately 20% of people with diagnosable alcohol use disorder qualify as highly functional, although some researchers believe this number is significantly higher, possibly 50 to 75%. Because people with high-functioning alcohol use disorder are able to mask their symptoms so well and may be in denial, it is more challenging to get accurate statistics.

People at the highest risk of high-functioning alcohol use disorder are more likely to:

  • Be middle-aged
  • Have a steady job
  • Be well-educated
  • Have stable relationships
  • Smoke cigarettes
  • Have a family history of AUD
  • Have experienced a major depressive illness

Some people with AUD that are highly functional are very successful, earn a high income, and appear to have a perfect life. Since they seem to have it all, others may not suspect they are hiding an alcohol dependence. Because of this, many people with high-functioning alcohol use disorder may not believe they have a drinking problem and do not seek treatment. 

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Common Signs of High-Functioning Alcohol Use Disorder

High-functioning alcohol use disorder can be harder to spot since the signs aren’t always obvious. If you’re worried that someone in your life may have a drinking problem despite seeming to have their life together, keep an eye out for the following signs of high-functioning AUD:

  • Drinking alone or secretly
  • Making jokes about drinking excessively
  • Drinking large amounts of alcohol without appearing drunk
  • Drinking at unusual or inappropriate times
  • Life seems to revolve around alcohol
  • Denial of a drinking problem

If you suspect a loved one is covering up an alcohol dependence, talk to them about cutting back on their consumption or seeking treatment to get alcohol misuse under control. 

Stages of High-Functioning Alcohol Use Disorder

Awareness of the stages of alcohol use disorder can alert you to when you or someone close to you is experiencing a drinking problem and need to moderate their consumption or get professional help. AUD typically progresses in the following way:

Stage 1: Experimenting with Alcohol

Early on, a person may drink occasionally or binge drink on the weekends or at social events.

Stage 2: Increasing Alcohol Consumption 

Drinking starts to happen more often, such as on weekdays, as opposed to just weekends, holidays, or other celebrations. Rather than serving as an elixir for socializing, alcohol starts to function as self-medication for stress, mental health issues, or other life struggles.

Stage 3: Alcohol Misuse Starts Disrupting Life

As alcohol tolerance develops and a person requires more alcohol to experience the same effects, they may also run into more problems due to their consumption. People who are high-functioning at this stage may not show obvious signs of AUD since they are better able to hide the consequences. However, mental health can decline, and they may struggle silently with feelings of anxiety, depression, stress, and isolation.

Stage 4: Development of Physical Symptoms 

As AUD progresses, a person will start to feel the effects on their health. They may experience high blood pressure, a bloated stomach, flushed skin, chronic acid reflux, and shaky hands. Although a person with high-functioning alcohol use disorder may seem to be doing fine, holding down their job and household responsibilities, the decline in their physical appearance may start to become noticeable to others.

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What personality traits lead to alcohol use disorder?

Research has shown that several personality traits are linked to the risk for alcohol use disorder:

  • Agreeableness 
  • Conscientiousness
  • Extroversion 
  • Impulsivity
  • Neuroticism
  • Novelty seeking
  • Openness to experiences

These traits don't necessarily mean that a person will develop AUD or drink at all, but it makes them more likely to consume or misuse alcohol. Researchers found that people who received AUD treatment and possessed these personality traits were at a higher risk for relapse unless they learned healthier ways to fulfill their needs. Noting the correlation between these traits and alcohol use disorder has helped improve addiction treatment options. 

How many drinks a day is considered as having an alcohol use disorder?

There isn't a specific number of drinks that indicates someone has an alcohol use disorder. However, there are guidelines for alcohol moderation and misuse. Drinking in moderation is considered up to one drink per day for women and two per day for men. There are two categories of alcohol misuse: binge drinking and heavy drinking. Binge drinking is considered four or more drinks within two hours for women and five or more for men. Heavy drinking is considered more than three drinks in a day for women or more than seven in a week. For men, this would be more than four drinks in a day or more than 14 in a week. The distinction between alcohol misuse and alcohol use disorder is that a person with AUD cannot moderate their consumption or stop drinking.

How can you tell if someone has a high-functioning alcohol use disorder?

It can be harder to tell if someone has a high-functioning alcohol use disorder. Some of the most noticeable signs include the ability to consume a large amount of alcohol without appearing intoxicated, which indicates a high tolerance. The person may also joke about drinking heavily but deny they have a problem.

How does someone with an alcohol use disorder act?

One of the primary differences between a person with alcohol use disorder and someone with high-functioning AUD is how they appear to others. People with high-functioning alcohol use disorder may seem like they have their life together despite heavy or binge drinking. Those not considered highly functional may exhibit a more obvious decline in physical appearance, mood swings, depression, and anxiety. They are also more likely to have trouble with work, school, finances, or relationships.

Stop High-Functioning AUD in Its Tracks with Confidant Health

The earlier you recognize the signs of a high-functioning alcohol use disorder, the easier it will be to address it. Confidant Health's medication-assisted treatment for alcohol use offers confidential online help for people struggling with AUD. Start healing with medication-assisted treatment by scheduling a virtual assessment today.

This article has been medically reviewed by
Erin Hillers
Erin Hillers
Erin Hillers
Nurse Practitioner

Erin is a Nurse Practitioner with 8 years of experience in midwifery and women's health. She has spent the past 5 years specializing in the treatment of opioid and alcohol use disorders.

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