Millions of Americans who have AUD are what’s considered high-functioning alcoholics. It’s challenging to find the signs of AUD in these people, as they are able to live their lives and manage their careers without any apparent difficulty.
A functioning alcoholic who is referred to as a “high-functioning alcoholic” may be able to carry out daily living activities. These activities can include jobs responsibilities, hygiene, child care, paying bills, or joining in social events. Individuals can participate in these activities without ever full displaying all the symptoms associated with alcohol use disorder.
A common misconception is that you have to be drunk frequently before you’re considered to be any kind of alcoholic. That’s the frustrating thing about this kind of ; you don’t binge, and you hardly ever get drunk.
What you do, though, is drink. Every day. It is easy to hide the disease because you aren’t drunk and disorderly, but you can’t get through the day without an alcoholic drink. Since you are drinking in a socially acceptable manner, no one realizes the toll that alcohol abuse is taking on your body and mind.
Below we have included a quiz to help you identify whether or not you or a loved one may be at risk of developing alcoholism.
This test is not a diagnostic tool, nor is it intended to replace a proper diagnosis. Use it only for informational purposes. Substance use disorders and addictions should only be diagnosed by a licensed behavioral health professional or doctor. Regardless of your results from our assessment, you should speak to a doctor about your substance use.
For decades, excessive use of alcohol was considered a sign of personal weakness. Fortunately, as the fields of psychiatry and neurology have progressed, experts now agree that alcoholism, or AUD, is a type of mental illness and is extremely difficult to control. AUD is preferred to alcoholic or alcoholism when describing the illness, as it is less stigmatized than saying you are an alcoholic.
The most recent version of the Diagnostic and Statistical Manual, DSM-5, classifies any kind of alcohol dependence or abuse—AUD— as a brain disorder, with mild, moderate, or severe levels of severity.
During the pandemic, almost 25% of adults in the US said they were drinking more to cope with stress, according to the American Psychological Association. In 2019, The National Institutes of Health (NIH) found that even more people admit to binge drinking—about 26%. The NIH defines binge drinking as 4 or more drinks for women, or 5 or more drinks for men, on a single occasion.
There is another disturbing trend in alcohol consumption—high-intensity drinking. This is defined as consuming twice the levels of binge drinking. High-intensity drinkers are almost guaranteed to have an alcohol-related visit to the emergency room.
Children—ages 12-17—are not drinking as much; from 2000-2019, consumption among children declined an average of 52% in all age groups.
In 2019, the National Survey for Drug Use and Health (NSDUH) found that over 14 million Americans have Alcohol Use Disorder (AUD). 414,000 adolescents also have AUD.
Heavy drinking can have a negative impact on several internal organs, but it can also literally alter your brain. These are some of the physical problems AUD causes.
Americans with AUD are also at higher risk for certain chronic and terminal diseases. The National Cancer Institute says that there is strong evidence that even moderate alcohol consumption can lead to several types of cancer. Head and neck cancers are common, as are esophageal, liver, breast, and colorectal cancers.
Your immune system can also suffer from too much alcohol consumption, as your body is weaker and can’t fight off infections as well. Pneumonia and tuberculosis are more likely when you drink heavily leading from alcohol withdrawal.
The characteristics of a high-functioning alcoholic are that there aren’t any. Although the NIH estimates that 20% of people with AUD fall into the high functioning category. If you’re a high-functioning alcoholic, you are not a stereotypical “drunk”. But you are an alcoholic.
You are a model citizen in the community, usually middle-aged, often with a solid career, strong family, and lots of friends and hobbies.
The need to drink is so woven into the fabric of their social lives that it’s hard for high functioning AUD sufferers to even recognize there is a problem.
There are many ways to determine whether you or someone you care about needs help. Some red flags to look out for include:
The reality is that in the US today, drinking is more socially acceptable than ever. But how do you know if your drinking is a problem? Plenty of Americans have a cocktail or a beer every day and aren’t high functioning alcoholics—what’s the difference?
Social drinkers are fine with not having a drink—they can go out and are perfectly fine with water, soda, tea—whatever. A high-functioning alcoholic is addicted to alcohol, and they crave the alcohol from the wine or beer in their systems. Frequently, the need to drink is stronger than your actual desire to drink—you’re addicted.
Alcohol use disorder is an addiction. For many people who have AUD, the perceived social stigma in admitting they have a problem outweighs getting help. If you have overwhelming cravings for a drink, please understand that this is a neurological impulse—not a sign of weak or flawed character.
One of the reasons that addiction is no longer so socially stigmatized is that modern technology lets researchers see brain images. And the brains of addicts, whether it’s drugs or alcohol, are different.
There are several parts of the brain that contribute to chemical dependency, the areas with dopaminergic neurons that control reward, memory, and inhibitions play an unusually large part in the desire and motivation for drinking or drug use. If you have AUD, you’ve probably noticed that the anticipation of that drink is a bigger rush than the drink itself—because your brain is hard-wired to crave more than to consume.
The neurotransmitters that send those cravings to your brain are simply a part of your DNA. This is not a matter of willpower, In fact, your neural signals are so strong that when you drink too much, they can literally rewire your neural pathways and enhance those cravings.
Your body’s response to this shift in your brain is to need more alcohol, and increase your stress response if you deny yourself that drink. It also reduces impulse control, so that you are more likely to give in to the craving. It’s truly a vicious cycle that gets worse with time.
When you’re an addict of any kind, your brain has a skewed rewards response. Everyone’s brain is wired to reward and reinforce positive behaviors—food, friends, sex—but if you have AUD, alcohol triggers the same reward response. This is why you consider a cocktail an important part of your day—the dopamine makes you do it.
The reality is that if you do have high functioning AUD, it’s a mental illness and your brain is relentless in its craving for another fix. Very few people hide their drinking from family and friends if there is no problem, and you certainly don’t get behind the wheel after you’ve been drinking if you’re not trying to hide anything.
One of the primary traits of a high-functioning alcoholic is that you hide the disease so well. You have a successful career, with lots of responsibilities and a bright future, and your drinking doesn’t interfere with your performance at work. Everybody goes out after work for a drink, or more likely these days, you have a beer over Zoom.
Or you manage the household and keep track of your kid’s schedules, get the laundry, cleaning, and cooking done, and still have time for your friends—where a glass of wine or two is the natural conclusion to your day. Surely this social drinking, one or two glasses a day, doesn’t make you a high functioning alcoholic. Does it?
If you are drinking too much, it’s common to assume that since you are successful and not the stereotypical drunk, there’s no problem. Or that you’re just going through a rough patch at home or work and you’ll get it under control once things settle down.
Another study by the RAND Corporation found that 41% of women had more “drinking days” during and since the pandemic than before. And according to another study by Harvard Medical School and UNC-Chapel Hill, women’s mental health is more at risk than their male counterparts. Women are twice as likely to suffer from alcohol-induced anxiety and depression.
Also, heavy drinking also worsens insomnia in women. What’s worse, the incidences of domestic violence between partners has increased stress levels with the combination of excessive alcohol use and Covid.
AUD does appear to run in families, and there are stories on the internet about an alcoholism “gene”. The NIH and CDC has found no evidence of such a gene, although genetics absolutely influences your chances of developing alcoholism.
Genetics are only half the story when it comes to alcoholism of any kind. Environmental factors account for the other half—do you live in an environment where drinking is encouraged?
Your genetic makeup is certainly hereditary, but there is no way to know the outcome of your unique genetic lottery. You may inherited genes that increase your risk of AUD or drug addiction, but it’s fifty/fifty that you didn’t. You could also have inherited a gene that alters your metabolic response to alcohol, resulting in nausea and a rapid heartbeat if you drink.
People who have this reaction to alcohol may say they are “allergic” and avoid drinking altogether. If these people also have the predisposition for AUD, chances are good that they won’t develop the disease because the unpleasant side effects of drinking outweigh the rewards.
If you are concerned about a loved one’s unhealthy alcohol use, start the conversation in a low-key, non-judgemental way, when the person is sober. Be honest but not dramatic about how this person’s drinking is affecting the people around them.
The drinker is likely to argue that they don’t have a problem, so many family members choose to stage an intervention . Interventions aren’t meant to bombard the person with AUD; rather, you should offer support when they seek help or have the desire to go to addiction center to receive treatment.
If you believe someone you love does have AUD, encourage them to talk with their doctor about the amount and frequency of their drinking. A primary care physician can run tests that indicate excessive alcohol consumption, and help find ways to address the disease. Sometimes, seeing lab results that show how alcohol is affecting your health is the eye-opener you need to admit your issues and get help.
If you don’t seek alcohol addiction treatment for your AUD, you’ll eventually lose your ability to function at a high level, and finally, at any level.
Your brain’s cravings for alcohol increase as you drink more; it’s like the worst version of the chicken and the egg. That is the definition of addiction—the more you feed the habit, the greater the habit grows.
Ultimately, untreated high functioning heavy drinking leads to the same risks as full-blown functional alcoholism. These risks include:
If you believe you are a high functioning alcoholic and have decided it’s time to face your addiction at an alcohol rehab center, let your family and friends know so they can be the support system you need. As they say, admitting you have unhealthy drinking habits is the first step to overcoming your dependence on alcohol.
You can recover, although you will always be tempted to take that first drink. Recovery from a substance use disorder or AUD is not the end game, but rather the ability to avoid the triggers that make you crave a drink.
It isn’t easy to admit that you have a problem, but having a great support system makes this first step easier. If you’re looking for resources because you’re living with an alcoholic, or if you seeking treatment, consider reaching out to No Matter What Recovery.
No Matter What Recovery is an outpatient treatment facility that specializes in alcohol misuse and alcohol treatment. Our multi-dimensional approach to substance abuse treatment is equipped to help anyone through the later stages of addiction treatment
Think hard about the informal quiz results, discuss them with your family, and consider your options for a treatment facility or alcohol rehab and recovery. If you think you might be a high functional alcoholic, please come and explore our options for long-term treatment and residential facilities.