Alcohol addiction affects people differently. Some people with alcohol use disorders experience severe, noticeable side effects. Others perform well at work, have seemingly happy family lives and don’t drink around the clock. A high-functioning alcoholic may seem to keep their lives together while drinking in secret, but chronic alcohol abuse always leads to negative consequences.
People suffering from alcohol addiction don’t always hit rock bottom. Many people keep their addiction secret and believe they control how much they consume.
They may never get fired for being hungover, have a falling-out with friends or get pulled over for driving under the influence. The side effects might not catch up to them until old age, when chronic alcohol abuse takes its toll on their liver, heart and brain.
These people are commonly referred to as high-functioning alcoholics. A high-functioning alcoholic might drink moderately throughout the day — never enough to get drunk but always enough to curb cravings and stave off withdrawal. Or they may remain sober throughout the day but binge drink at night or on weekends.
But they have an addiction as real as those of the people who get in car accidents, show up to work drunk or lose their family and friends.
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The American Psychological Association classifies substances use disorders as mild, moderate or severe. The severe cases are obvious. They’re highlighted on TV and in the news. But mild and moderate cases may be more common, affecting millions across the U.S.
In 2007, Columbia University researchers found that 4 percent of Americans had an alcohol use disorder.
In 2007, Columbia University researchers analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions. They found that 4 percent of Americans had an alcohol use disorder. Among the 4 percent, 3 percent — about 9 million people — were considered functionally dependent.
Alcoholics have a stereotype, so friends, family members and co-workers might not recognize high-functioning alcoholics.
The term high-functioning is misleading, though. Some experts prefer the term “currently-functioning alcoholic” because odds are such people aren’t going to be high-functioning forever. They might not even continue to abuse alcohol forever.
The Columbia researchers found that about 72 percent of people who become dependent on alcohol overcome the disease, with or without treatment, within three or four years and do not relapse. The prognosis for the other 28 percent isn’t as encouraging. They relapse an average of five times and must work to remain sober for the rest of their lives.
People with alcohol use disorders don’t fall into either a highly functional or dysfunctional category. In fact, every person experiences different symptoms and side effects of the disease.
However, researchers from the National Institute on Alcohol Abuse and Alcoholism developed five general subtypes of alcoholism. Based on family history, age of initiation, symptoms and the presence of co-occurring disorders, they classified alcoholics as:
“Our findings should help dispel the popular notion of the ‘typical alcoholic,’” said Dr. Howard Moss, NIAAA associate director for clinical and translational research, in a news release. “We find that young adults comprise the largest group of alcoholics in this country, and nearly 20 percent of alcoholics are highly functional and well-educated with good incomes.”
In the study, only 20 percent were considered “highly functional,” but a high-functioning alcoholic can be found in any of the subtypes except chronic severe.
The young adult subtype comprises about 31 percent of American alcoholics. They do not typically suffer from co-occurring disorders, don’t usually have a family history of alcoholism and rarely seek treatment.
The young antisocial subtype makes up about one-fifth of alcoholics. They are usually in their mid-20s, began drinking at a young age and began experiencing problems with alcohol abuse at a young age.
More than 50 percent of them have a family history of alcoholism and an antisocial personality disorder. More than three-quarters of them smoke cigarettes or marijuana, a large portion suffer from cocaine or opioid addiction, and more than 33 percent eventually seek treatment.
About one-fifth of American alcoholics fit into the functional subtype. They’re middle-aged, well-educated and have stable family lives and careers. About 33 percent have a family history of alcoholism, 25 percent have suffered from depression and about 50 percent smoke tobacco.
Another fifth fit into the intermediate familial subtype. This group is middle-aged, and half have a family history of alcoholism. About 50 percent have experienced depression, and one-fifth have suffered from bipolar disorder. A majority of them smoke cigarettes, and one-fifth have experienced problems with cocaine or marijuana abuse. Only a quarter of them seek treatment.
The chronic severe is composed of 9 percent of alcoholics. They’re usually middle-aged, began drinking at a young age, suffer from an antisocial personality disorder and have a history of law enforcement problems. About 80 percent have a family history of alcoholism, many have co-occurring disorders and many suffer from marijuana, cocaine or opioid addiction. Two thirds of them seek treatment.
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High-functioning alcoholics are difficult to recognize because they try to keep their addiction a secret. They may be in denial about their addiction, so they’re unwilling to accept help or admit they need help. Often, only a select few friends, family members or spouses are close enough to recognize the signs.Signs that someone is a high-functioning alcoholic include:
High-functioning alcoholics are more likely to participate in high-risk behavior, but they may be better at not getting caught than others. Examples of high-risk behaviors include:
Alcoholism never occurs without consequences. Some alcoholics may be highly functional at work, in school or in social situations, but the negative effects of the disease will eventually show up somewhere.
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People with alcohol use disorders, including those with mild types, often isolate themselves to hide how much they drink. They may experience legal problems, usually in the form of a DUI or after an accident involving drinking. Chronic alcohol consumption often leads to mental health problems such as depression or other health issues such as high blood pressure, liver problems or heart problems.
High-functioning alcoholics don’t remain highly functional forever. If you think you or someone you know is a high-functioning alcoholic, even someone with a mild alcohol use disorder, don’t wait until problems occur. DUIs, trouble at work and family drama can be avoided by seeking help before the disease progresses.
Research suggests that some high-functioning alcoholics never experience major problems, but they also never live life to their full potential.
“Although their lives do not fall apart, their excessive drinking may be a matter of significant concern for them and their loved ones,” said Dr. Moss of the NIAAA. “In this way, people with functional alcohol use disorders resemble others with major depression or anxiety disorders who are able to function but at a suboptimal level and with a significant level of distress.”
There is nothing shameful about suffering from alcoholism. But if you don’t want others to know you’re in recovery, you can attend outpatient treatment or attend anonymous support group meetings. Recovery from alcoholism is possible with dedication and perseverance.