Learn / How to Recognize High-Functioning Alcohol Addiction

How to Recognize High-Functioning Alcohol Addiction

Kayla Gill
 May 24th, 2022|   Clinically Reviewed by 
Rajnandini Rathod

If you’re keeping up the appearance of a healthy lifestyle, it can be hard to know whether you have a high-functioning alcohol addiction. However, this condition can have just as many negative effects as more recognizable alcohol misuse. If drinking is having any negative impact on your life at all, you don’t have to wait for the problem to get worse. By connecting with a rehab that treats high-functioning alcohol addiction, you can assess your own behaviors. And, if necessary, you can get the help you need to start recovery.

When Drinking Becomes a Problem

According to the CDC, drinking in moderation is defined as “limiting intake to 2 drinks or less in a day for men or 1 drink or less in a day for women, on days when alcohol is consumed.”1) Note that these gender differences are based on scientific research, and not on evolving social norms. Also, keep in mind that a “standard” drink has only 14 grams of pure alcohol. These are examples of what counts as one drink,2 according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA):

  • 12 ounces of regular beer (usually about 5% alcohol)
  • 5 ounces of wine (12% alcohol)
  • 1.5 ounces of distilled spirits (40% alcohol)

These numbers are far lower than most people assume. And even in casual settings, friends may unintentionally enable you to drink more than you should. They may not recognize the signs of high-functioning alcoholism at first—and as a result, you may not immediately get the support you need.

Alcoholism Hides in Plain Sight

Drinking is a normalized activity in most cultures around the world, and some people can drink without developing an alcohol use disorder.3 Because drinking is so socially acceptable, however, it can be difficult to realize or admit that you have this particular addiction. People with high-functioning alcohol use disorder are often said to be leading double lives, in which everything looks perfect to a casual observer. However, the underlying reality is much more dangerous than it appears.

Someone with a high-functioning alcohol addiction can still function in their daily lives, despite heavy alcohol use. People around them may not realize the amount of alcohol they’re drinking, although they may have suspicions. Someone with a high-functioning alcohol addiction may still perform well at work, spend time with family and friends, and participate in hobbies, all while consuming much more alcohol than what experts consider healthy.

“My Success was the Mask”

Sarah Allen Benton is a mental health counselor who once had a high-functioning alcohol addiction4 herself, although you might have never guessed—she has a Master’s degree from an esteemed university and a job as a mental health counselor at a prestigious college in Boston. She recounted her experience in an interview with the New York Times:

“Having outside accomplishments led me and others to excuse my drinking and avoid categorizing me as an alcoholic. My success was the mask that disguised the underlying demon and fed my denial.”

In the same interview, she went on to describe the following criteria, which may help you determine whether your drinking is, in fact, problematic:

  • You can’t seem to control how much you drink, even if you set intentions to limit your alcohol intake.
  • You think about alcohol obsessively, making plans around the next time you’ll be able to drink.
  • Your behavior when you’re sober is markedly different than it is when you’ve been drinking.
  • You sometimes drink so much that you black out.

“It’s not the number of drinks that defines [someone with an alcohol addiction],” said Ms. Benton. “It’s what happens to you when you’re drinking.”

Deciding to Get Sober

High-functioning alcohol addiction is a common condition—probably more common than most people realize. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that about 19.5% of alcohol addictions in the U.S. are considered high-functioning,5 and most people are well-educated with secure careers and families. Even if your life appears to be sustainable, you might still benefit from receiving care.

If you recognize the signs of alcohol addiction in a loved one, you may be able to help them get treatment. Make sure you care for yourself by setting appropriate boundaries throughout this process. Remember that their condition is not your fault—and ultimately, it’s not your responsibility to “fix” the problem.

When people do decide to seek treatment for high-functioning alcohol addiction, it’s often because of concern from others. They may also experience a “wake-up call” that makes them fear for their own safety. For example, someone may realize the severity of their alcohol addiction after a DUI, an arrest, or a serious health problem that arises related to your drinking.

Starting Recovery from High-Functioning Alcohol Addiction

When you’re ready to get treatment for a high-functioning alcohol addiction, you can choose between a variety of healing modalities. For alcohol, even more than other substances, it’s important that you begin healing under proper medical supervision.

Medical Detox

You may need to undergo medically supervised detox, depending on the severity of your alcohol use. During this time, a team of medical professionals will supervise you throughout the process and help ease your withdrawal symptoms. This may involve the use of non-addictive medications to help make you feel more comfortable. Even people who can perform the functions of daily life may be drinking at a level that requires detox, and it’s extremely dangerous to attempt this process alone. It’s very important that you seek medical advice before you begin detoxing, as withdrawal can be fatal without proper care.

Remember that detox is not recovery, but a preliminary step to receiving treatment. To fully and sustainably overcome any addiction, you’ll need to work on the underlying issues that caused it. This may require residential addiction treatment, or some combination of the treatment methods listed below.

Inpatient Rehab

During inpatient treatment, patients stay at a rehab facility, usually for a minimum of 28 days. You’ll work with therapists and most likely attend both 1:1 sessions and group therapy, in addition to receiving medical attention when needed. Depending on your specific rehab program, you may also participate in therapeutic activities such as hiking or swimming.

Each treatment facility is different. Some rehabs have a special focus on treating alcohol addiction, while others would be a good fit for patients with co-occurring disorders. Whatever your diagnosis, your time in residence should help you plan for a future without alcohol. Remember that while inpatient rehab will allow you to begin the healing process, recovery continues after you return home.

Intensive Outpatient Programs

In some situations, you may choose to attend an intensive outpatient program (IOP) instead of staying at a residential rehab. This type of treatment is often appropriate for patients who would benefit from treatment, but can’t spend that much time away from home due to work, school, family, or other time commitments. Your insurance might also cover an IOP even if it won’t cover inpatient treatment.

During an IOP, you’ll live at home and attend therapy and other treatments during the day. You may be onsite for several hours a day, several days a week; the time commitment is similar to that of a job. This flexibility is very important for some patients, but it’s not sufficient for everyone. You may still be vulnerable to triggers at home that you wouldn’t encounter while attending an inpatient rehab.


The U.S. Food and Drug Administration (FDA) has authorized 3 medications for treating alcohol dependence:6

  • Naltrexone makes drinking less desirable by blocking the pleasurable effects of alcohol.
  • Acamprosate reduces alcohol cravings.
  • Disulfiram causes uncomfortable symptoms —such as nausea and flushing of the skin—if you drink, making alcohol less appealing.

A medical professional can prescribe these non-addictive medications for use alone or along with other forms of treatment. You may have to experiment to find which medications work best for you. You can also choose to combine these medications with talk therapy, or if using medication doesn’t work for you, focus on talk therapy alone.

Talk Therapy

According to the National Institute on Alcohol Abuse and Alcoholism, there are several different behavioral therapies that may successfully treat alcohol addiction.6 These may include 1 or more of the methods below.

  • Cognitive behavioral therapy (CBT) focuses on helping you change your own thoughts and behavioral patterns from negative to positive. This treatment helps you understand the feelings and situations that may trigger you to drink, and teaches strategies for managing that stress in a healthy way.
  • Motivational enhancement therapy helps you find the motivation to change your drinking habits. During these sessions, you’ll create a plan to stay sober, focus on building your confidence, and develop the skills you need to stay on track with your plan.
  • Family therapy works on healing the relationships between spouses and within families, since support from loved ones is crucial during the recovery process.

Support Groups

Social support is extremely beneficial when recovering from alcohol abuse.7 Research has found that people with bigger social circles and stronger relationships have a greater likelihood of abstaining from alcohol. If you’re looking to build relationships with people who can support you during recovery, you may benefit from attending a support group.

Alcoholics Anonymous (A.A.)8 is a free program that is “open to anyone who wants to do something about their drinking problem.” Members can attend peer-led meetings regularly or casually in order to share mutual support. This 12-Step program’s primary goal is to help people achieve sobriety through 12 spiritual principles.

Faith-based recovery is right for some, but not for everyone. Other free support groups, like SMART Recovery,9 are available for people who prefer a more scientific approach. In any group, you’ll have the opportunity to connect with people who share your experience.

Social support is a hugely important component of recovery. You can find that support in groups, and also by strengthening relationships with friends, family, and chosen family who want to see you heal. Some rehab programs have an especially strong focus on this issue, and will incorporate it into your process of planning for aftercare. Depending on your exact needs, your relapse prevention plan may include personal relationships, ongoing therapy, a rehab alumni network, and in-person or online support groups.

Sober Living Environments

After you’ve completed treatment, you may choose to stay in a sober living home (also known as a therapeutic community) before transitioning to life back home. This entails living with others in recovery, which will allow you to exchange mutual support and build relationships with people at a similar stage of their journey.

Sober living environments allow you to start reintegrating into the wider world, while still providing the structure and support of a substance-free environment and recovery-focused daily schedule. Not everyone needs sober living, but it can be a great fit for some while stepping down from residential care.

It’s important to note that each of these communities has their own set of rules. For example, you may be required to attend therapy, participate in group activities, or test negative for drug and alcohol use in order to maintain residence. This kind of structure is designed to support your continuing process of recovery.

Long-Term Effects of Alcohol Abuse

Long-term exposure to alcohol can impact on every aspect of your health. Alcohol addiction can even change your brain chemistry,10 affecting the function of neurotransmitters. As you progress in your recovery journey, you may need to make long-term plans not just for your mental health, but also for your physical recovery.

Physical Effects

High-functioning alcohol addiction can sneak up on you. As your alcohol tolerance slowly increases, you may find yourself drinking more and more just to achieve the same effect. Many people don’t even realize the sheer quantity of alcohol they’re consuming on a regular basis. And unfortunately, higher alcohol consumption is associated with more severe health risks, regardless of how intoxicated it makes you feel.

High-functioning alcohol addiction can cause a plethora of negative effects on the body.11 Over time, alcohol misuse can cause problems with your heart, liver, pancreas, and brain. Research has found neurons in the brain may become smaller in size due to alcohol misuse,12 causing cognitive dysfunction. You may develop a compromised immune system, which can make you more vulnerable to disease and illness, and can even lead to cancer. Eventually, consistent alcohol abuse can be fatal.

Social and Emotional Problems

Alcohol misuse has a negative effect on mental health,13 and increases your risk for depression and anxiety. Excessive drinking also causes social challenges,14 and may damage the most important relationships in your life. When you stop drinking, you can expect your social circle to change significantly—and not always in the ways you might expect.

In the best case scenario, you’ll be able to repair relationships that were undermined by your addiction. However, you’ll probably also need to let go of relationships with people who once enabled your behavior. Research has found that it’s more likely for people to begin drinking again when they surrounded themselves with loved ones who still drank alcohol7 and encouraged drinking. The opposite was true for people who spent more time around sober friends and family. Never underestimate the importance of strong, supportive relationships during your recovery. According to one study, positive support from friends was the most important predictor in abstinence from alcohol7 for adults.

You can live a full, happy life that’s also a sober one. And in order to do that sustainably, you’ll learn how to enjoy yourself while sober. That could mean going on early morning hikes, taking up painting, or learning how to cook. The good news is, you can still do these things with the important people in your life. In fact, many people find they have more fun in recovery than they did while they were drinking – and that their relationships are more genuine.

Get Your Life Back in Recovery

Although it may seem difficult to imagine life without alcohol now, it’s entirely possible. Recovery isn’t just about abstaining from substances—it’s about creating a life that you love. And that has everything to do with discovering what fulfills you and finding a lifestyle that’s aligned with your values.

The most important thing to remember is that recovery is about what works best for you. Only you can determine what your life will look like moving forward, but know that support is available to help you get there.

If you’re concerned about your drinking, learn more about available programs and connect with admissions team members who can offer you an initial assessment via our directory of inpatient alcohol rehabs.

Reviewed by Rajnandini Rathod

  1. Facts about moderate drinking | CDC. (2022, April 19). https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm []
  2. What is a standard drink? | national institute on alcohol abuse and alcoholism(Niaaa). (n.d.). Retrieved May 24, 2022, from https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption/what-standard-drink []
  3. Witkiewitz, K., Litten, R. Z., & Leggio, L. (2019). Advances in the science and treatment of alcohol use disorder. Science Advances, 5(9), eaax4043. https://doi.org/10.1126/sciadv.aax4043 []
  4. Brody, J. E. (2009, May 4). High functioning, but still alcoholics. The New York Times. https://www.nytimes.com/2009/05/05/health/05brod.html []
  5. Researchers identify alcoholism subtypes. (2015, September 29). National Institutes of Health (NIH). https://www.nih.gov/news-events/news-releases/researchers-identify-alcoholism-subtypes []
  6. Treatment for alcohol problems: Finding and getting help | national institute on alcohol abuse and alcoholism(Niaaa). (n.d.). Retrieved from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help#pub-toc1 [] []
  7. Groh, D. R., Jason, L. A., Davis, M. I., Olson, B. D., & Ferrari, J. R. (2007). Friends, family, and alcohol abuse: An examination of general and alcohol-specific social support. The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions, 16(1), 49–55. https://doi.org/10.1080/10550490601080084 [] [] []
  8. What is a. A.? | alcoholics anonymous. (n.d.). Retrieved from https://www.aa.org/what-is-aa []
  9. Self-help addiction recovery program | addiction support groups. (n.d.). SMART Recovery. Retrieved from https://www.smartrecovery.org/ []
  10. Brochures and fact sheets | national institute on alcohol abuse and alcoholism(Niaaa). (n.d.). Retrieved from https://pubs.niaaa.nih.gov/publications/aa77.pdf []
  11. Alcohol’s effects on the body | national institute on alcohol abuse and alcoholism(Niaaa). (n.d.). Retrieved from https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body []
  12. Alcohol and the brain: An overview | national institute on alcohol abuse and alcoholism(Niaaa). (n.d.). Retrieved from https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-and-brain-overview []
  13. Understanding alcohol use disorders and their treatment. (n.d.). Https://Www.Apa.Org. Retrieved from https://www.apa.org/topics/substance-use-abuse-addiction/alcohol-disorders []
  14. Rehm, J. (2011). The risks associated with alcohol use and alcoholism. Alcohol Research & Health, 34(2), 135–143. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3307043/ []

Return to Resource Library

Our Promise

How Is Recovery.com Different?

We believe everyone deserves access to accurate, unbiased information about mental health and addiction. That’s why we have a comprehensive set of treatment providers and don't charge for inclusion. Any center that meets our criteria can list for free. We do not and have never accepted fees for referring someone to a particular center. Providers who advertise with us must be verified by our Research Team and we clearly mark their status as advertisers.

Our goal is to help you choose the best path for your recovery. That begins with information you can trust.