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Should I Get Help for My Drinking? Signs of High-Functioning Alcoholism
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When we think of “alcoholism,” the first thing that comes to mind probably isn’t an accurate reflection of how alcohol addiction really works. Unfortunately, stigmas and media portrayals of alcoholism leave us all with the impression that an “alcoholic” is someone who acts belligerently, who’s lost everything and whose life is in shambles.
But the reality is far more nuanced than that. Many “alcoholics” are people who seem to have it completely together and privately struggle with alcohol addiction. And many of these people may not even realize that their level of drinking is a problem—until something gives.
Because high-functioning alcoholism is so easy to ignore, it often takes an event like a health scare, an accident, or simply an accumulation of harmful patterns to realize it’s a problem. And once this happens, you might begin to see that what you once considered harmless behavior actually impacted your life far more than you thought.
If you’re starting to question your drinking, you may be wondering if it’s really a problem, if it requires treatment, and what the right course of action is to address it.
We look at warning signs, drinking guidelines, and treatment options for problem drinking.
What Qualifies as “Alcoholism,” or an Alcohol Use Disorder?
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the U.S. National Institutes of Health, researches alcohol-related problems. According to its definition of alcohol use disorder (AUD),1 “AUD is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.” This can happen at mild, moderate, or severe levels.
Clinicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose alcohol use disorders. Signs they may look for include
- drinking more, or for a longer period of time, than you plan to;
- trying to stop drinking, but being unable to;
- spending a substantial amount of time drinking or being hungover;
- experiencing withdrawal symptoms like sleeplessness, racing heart, or sweating when you stop drinking;
- engaging in high-risk behavior, like driving, having unprotected sex, or otherwise putting yourself in danger, while intoxicated; and
- feeling increased anxiety or depression as a result of your drinking.
These are just some of the many symptoms associated with problem drinking, but one or more of the above are likely to appear on your radar if you’ve developed an issue with alcohol. It’s important to get an assessment by a qualified clinician to paint an accurate picture of what’s going on, and as a first step to creating a treatment plan.
Guidelines for “Moderate” Drinking
Many alcohol ads say “drink responsibly,”2 but what does that even mean?
While alcohol may not yet have caused dramatic consequences in your life, you may still be wondering just how bad drinking heavily, or every day, is for your health.
Drinking guidelines vary by country. In the U.S., the Centers for Disease Control and Prevention (CDC) sets dietary guidelines for alcohol,3 outlining what it considers “moderate” drinking.
Consuming alcohol at any level increases health risks. These may be caused by incidents that happen while impaired, or by conditions like heart disease and certain types of cancers that develop over time, says the CDC:
“The risk of these harms increases with the amount of alcohol you drink. For some conditions, like some cancers, the risk increases even at very low levels of alcohol consumption (less than 1 drink).”
So while there’s no safe level of drinking, public health agencies acknowledge that drinking less is better than drinking more. The 2020-2025 Dietary Guidelines for Americans sets the limit for moderate drinking6 at 2 drinks or less in a day for men, or 1 drink or less in a day for women.
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Signs of High-Functioning Alcohol Addiction
It can be tricky to see this type of alcohol use disorder for what it is, especially when you’re in the midst of it. Here are some signs to watch out for.
Denial
People who struggle with high-functioning alcohol addiction may still manage to excel at work and maintain partnerships and families. This is no coincidence: many high achievers use alcohol to relieve the pressures of their professional lives. In fact, high stress levels and mental health conditions like anxiety are risk factors for alcohol use disorders.7
It’s easy for functional alcoholics8 to convince themselves that they’re doing fine, because fewer concrete consequences point to an alcohol problem and they haven’t “hit rock bottom” yet. And because they have a hard time seeing their behavior as problematic, they’re less likely to get help. But this doesn’t mean they’re not vulnerable to the same consequences as those who are more obviously struggling with alcohol addiction.
A functional alcoholic, says Dr. Robert Huebner of the NIAAA, “isn’t doing fine.” That’s because “[no one] can drink heavily and maintain major responsibilities over long periods of time. If someone drinks heavily, it is going to catch up with them.”
Increasing Tolerance
Increasing your tolerance may make you feel like you’re managing alcohol better, but the reality is that this results in increased drinking—and the greater risks that come along with it. The risks of consuming more than 14 drinks a week5 include nervous system and cognitive impairment, liver disease, stroke, and cancer. Drinking at this level is also known to worsen mental health conditions.
Here are some other signs to watch out for:
- Needing a drink to wind down after work or feel comfortable in social settings
- Using meals as a reason to start drinking
- Getting more drunk than you intend to
- Calling in sick to work due to hangovers
- Losing friendships or partnerships due to alcohol-related conflicts
- Hiding how much you’re drinking
- Joking about having a drinking problem
- Blacking out more easily
Problem drinking varies from person to person, but the bottom line is that alcohol becomes a problem when it results in unwanted outcomes in your life. If this is the case for you, following are some options for addressing it.
Treatment Options for Alcohol Use Disorder
According to the NIAAA, “The good news is that no matter how severe the problem may seem, evidence-based treatment with behavioral therapies, mutual-support groups, and/or medications can help people with AUD achieve and maintain recovery.”4
Your primary care provider or another qualified mental health professional is a good starting point for creating a treatment plan. Your path to recovery might include one or several of the following options:
Residential Alcohol Rehab
Residential, or inpatient, treatment, often known as “rehab,” entails living on-site at a treatment facility while attending daily therapy. Most residential rehabs offer group and individual sessions, as well as complementary therapies and activities. This intensive option gives you the opportunity to step away from your daily environment and focus entirely on creating life changes.
Outpatient Treatment
Outpatient treatment involves a regular schedule of therapy that may still be intensive, but allows you to continue working and living at home while attending treatment. This may be a good option for people who are still functional enough to manage their triggers and therapeutic challenges along with their daily responsibilities, but prefer a structured program that encourages significant progress.
Virtual Therapy
A great option for those who find in-person treatment cost-prohibitive or physically inaccessible, virtual therapy allows you to attend sessions via video conferencing or over the phone. These may take place with an individual therapist or within the context of a web-based alcohol treatment program.
Support Groups
Support groups like AA, as well as non-12-Step groups like SMART Recovery and other substance-free social groups, are also available online and in-person. Regardless of which treatment option you choose, finding a sober community is an important part of maintaining long-term sobriety. Relating to others with shared experiences is also a powerful way to break through denial.
To learn more about alcohol treatment programs that could be a good fit for you, explore our collection of independently evaluated alcohol treatment centers here.
Frequently Asked Questions About High-Functioning Alcohol Addiction
What qualifies as “alcoholism” or an alcohol use disorder?
Alcohol use disorder (AUD) entails impaired control over alcohol consumption despite adverse consequences in social, occupational, or health areas. Signs of alcohol addiction include excessive drinking, unsuccessful attempts to quit, spending significant time on drinking-related activities, withdrawal symptoms, engaging in high-risk behavior while drunk, and increased anxiety or depression related to drinking.
What are the guidelines for “moderate” drinking?
While there’s no truly safe level of alcohol consumption, moderate drinking is considered less harmful. The CDC suggests moderate drinking means no more than 2 drinks per day for men and 1 drink per day for women. However, consuming any amount of alcohol carries health risks and can lead to adverse outcomes like increased risk of accidents, heart disease, certain cancers, and worsened mental health conditions.
What are the treatment options for high-functioning alcoholism?
If you’re worried about your drinking, the good news is that effective treatment options are available. Evidence-based treatments, including behavioral therapies, mutual-support groups, and medications, can help people with alcohol addiction achieve and maintain recovery. Consider reaching out to your primary care provider or a qualified mental health professional to create a personalized treatment plan. Treatment options may include residential alcohol rehab, outpatient treatment programs, virtual therapy, and maintenance via support groups like Alcoholics Anonymous (AA) or SMART Recovery. Finding a supportive community can play a crucial role in long-term sobriety and breaking through denial.
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Understanding Alcohol Use Disorder | National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
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Benham, Barbara, and JH Bloomberg School of Public Health. “‘Drink Responsibly’ Messages in Alcohol Ads Promote Products, Not Public Health.” Johns Hopkins Bloomberg School of Public Health, https://www.jhsph.edu/news/news-releases/2014/drink-responsibly-messages-in-alcohol-ads-promote-products-not-public-health.html
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Facts about Moderate Drinking | CDC. 19 Feb. 2021, https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm
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Understanding Alcohol Use Disorder | National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
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“The Risks of Drinking Too Much.” National Health Service UK, 3 Oct. 2018, https://www.nhs.uk/live-well/alcohol-support/the-risks-of-drinking-too-much/
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Top 10 Things You Need to Know About the Dietary Guidelines for Americans, 2020-2025 | Dietary Guidelines for Americans. https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials/top-10-things-you-need-know-about-dietary
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Smith, Joshua P., and Carrie L. Randall. “Anxiety and Alcohol Use Disorders.” Alcohol Research : Current Reviews, vol. 34, no. 4, 2012, pp. 414–31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860396/
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Bienvenu, Melissa. “Am I a High-Functioning Alcoholic? Know the Signs.” WebMD, https://www.webmd.com/mental-health/addiction/high-functioning-alcoholic
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