Living with a High-Functioning Alcoholic: Signs and Support

High-functioning alcoholics deny their drinking is a problem, swayed by their success. Here’s how to identify the warning signs, avoid codependency and seek support.

Alcoholism can take a devastating toll on a person’s physical health, emotional well-being, personal relationships and professional life. However, many alcoholics manage to function effectively, holding down jobs and maintaining households. A high-functioning alcoholic may hide their alcohol abuse for years without suffering any major losses. Under the surface, this form of alcoholism can cause severe psychological and emotional damage to the alcoholic and also their loved ones..

There are at least two categories of people involved in alcoholism:

1. Functioning alcoholics (high-functioning alcoholics)
2. Individuals who struggle with living a normal life as a result of their alcoholism

Functional alcoholics differ from those who struggle with alcoholism, primarily in how alcohol affects their lives. If you’re the loved one of someone in either group, it’s important to know how to deal with an alcoholic effectively if you want to help them get well.

Whether you have an alcoholic spouse, partner or other loved one, you may be wondering how to help. High-functioning alcoholics can benefit from having an at-home support system before, during and after any form of treatment for their addiction. There are hundreds of resources all over the country designed to address the issue of alcohol abuse and addiction. These include 24-hour hotlines, detox centers and rehab facilities.

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What Is a High-Functioning Alcoholic?

“High-functioning alcoholic” is not a formal clinical diagnosis found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Instead, it is a colloquial term used to describe someone who meets the criteria for an alcohol use disorder yet still manages to keep up appearances. They might maintain employment, handle many of their day-to-day responsibilities and even thrive in certain social or professional settings. However, the façade of control and stability typically masks an underlying problem with alcohol that can be just as severe and damaging as more overt forms of alcoholism.

Despite being commonly referred to as “functional” in some areas of life, high-functioning alcoholics often grapple with the same cravings, withdrawal symptoms, mental health issues and health complications experienced by anyone else with alcohol dependence. The difference is that they’ve developed strategies to hide or rationalize the extent of their drinking. In many cases, they may not even fully recognize the severity of the issue themselves because their outward success seems to contradict the stereotype of alcoholism.

Moreover, the illusion of control can make it more difficult for friends, family members and colleagues to recognize a problem. High-functioning alcoholics can excel in high-pressure environments, maintain stable relationships (at least on the surface) and may even use social or cultural norms around drinking to camouflage their alcohol misuse.

What Makes Dealing with High-Functioning Alcoholics so Challenging?

Functional alcoholics are often in deep denial about their problem. After all, they have managed to maintain the appearance of success despite their addiction. But most high-functioning alcoholics have friends or loved ones who help them cover up the consequences of their drinking. These individuals may unconsciously encourage or enable the alcoholic’s behavior by allowing the alcoholic to avoid the negative consequences of destructive drinking.

What Percentage of Alcoholics are Functioning or High Functioning Alcoholics?

Nearly 20% of alcoholics are highly functional and well-educated with good incomes. Because these types of users appear stable and mostly unaffected by their drinking, the steps to effectively confront a functioning alcoholic and work with them on their behaviors can be even more difficult.

Warning Signs of a High-Functioning Alcoholic

High-functioning alcoholics will rarely admit that they have a problem. But if someone in your life has three or more alcoholic beverages per day (two or more for women), they are consuming more than the recommended amount. U.S. Dietary Guidelines define moderate drinking as one drink per day for women and up to two drinks per day for men. Binge drinking is defined as having four or more beverages in one drinking episode for women and five or more beverages for men (a typical drinking episode is around two hours).

The National Institute of Alcohol Abuse and Alcoholism estimates that nearly 20% of all alcoholics may be classified as “high-functioning.” High-functioning alcoholics tend to display specific behaviors that can help you identify this problem:

• Uses alcohol for confidence
• Drinks in the morning
• Drinks alone
• Drinks too much
• Blacks out while drinking
• Physical signs of alcohol withdrawal
• Has a record of DUI arrests
• Jokes about having an alcohol problem
• Misses school or work for unexplained reasons
• Gets angry when confronted about alcohol problems

Functional alcoholics are often intelligent, hardworking and well-educated. Their professional status or personal success can make it hard to approach them about having a “problem” with alcohol. However, it is impossible to continue drinking heavily for a long period of time without suffering the physical and psychological consequences of alcoholism, such as liver disease, heart disease, neurological damage, cancer or depression.

Typical Stages of High-Functioning Alcoholism

Stage 1: Using Alcohol as a Coping Mechanism

While many people enjoy having a few drinks occasionally, a functioning alcoholic takes this a step further. They begin to rely on alcohol to manage the stressors of a normal workday or to numb the effects of mental health issues like depression or anxiety. They may use alcohol “just to get going” or to “take the edge off.”

Functional alcoholics drink to feel better.

While their appearance may not be any different, and they can still fulfill their responsibilities, you’ll start to see a pattern develop of turning to alcohol to cope with family, work or personal issues.

Stage 2: Increased Alcohol Tolerance

People can have a varied reaction and tolerance to alcohol,l and that doesn’t necessarily mean they are alcoholics. However, as functioning alcoholics drink more regularly, they develop a higher tolerance. They still want to feel the buzz or numb out from their problems for a while, so they will begin drinking more as their tolerance to alcohol increases.

You may begin to notice that a couple of beers after work has turned into a six-pack or even a case. Or, a glass of wine has become the bottle. As time goes on and tolerance increases, they may attempt to hide the growing problem, and a growing number of empty bottles or cans, from friends and family.

Stage 3: Excuses

As their reliance on alcohol increases, you may begin to notice that your loved one downplays the role alcohol has in their lives and makes excuses for their actions, especially their drinking.

They may also withdraw from social situations and find excuses to miss events or optional commitments where drinking is not available or possible. There may also be new legal issues arising for them, like driving under the influence or making other poor decisions.

Stage 4: Physical Consequences

Liver damage is the most talked about physical consequence and that is a concern almost immediately. Alcoholics can go on to develop heart, respiratory and gastrointestinal disorders. There can also be declines in their mental and overall health, especially if they’re not eating healthy diets or engaging in physical activity.

Even though they may want to stop, many functioning alcoholics often won’t know where or how to begin the process. This is where family, friends and medical professionals can work together to create a plan to help end this cycle before they do more harm to themselves.

Related Topic: Am I an alcoholic

High-Functioning vs. Non-High-Functioning Alcoholism

When people think of alcoholism, they often picture a pattern that disrupts almost every aspect of an individual’s life. While this “non-high-functioning” alcoholism is certainly prevalent and destructive, the difference between these two types is often a matter of how well someone can mask or compartmentalize the consequences of their drinking.

• Level of Daily Functioning:
  High-functioning alcoholics manage to meet many daily obligations: They hold down jobs, pay bills and often maintain outwardly stable relationships. Non-high-functioning alcoholics typically experience obvious work impairments, repeated legal issues (like DUIs or public intoxication charges), financial hardship and unstable personal relationships.
• Visibility of the Problem:
  Someone with non-high-functioning alcoholism often has a more apparent struggle with addiction. They may be visibly intoxicated, show up to work hungover or regularly drink in socially unacceptable settings. High-functioning alcoholics, by contrast, are often adept at hiding their misuse. They may limit their drinking to certain “acceptable” times or places, or seamlessly weave their alcohol use into business functions and social gatherings.
• Types of Consequences:
  Both forms of alcoholism carry serious consequences, but they can appear differently. For non-high-functioning alcoholics, negative outcomes (loss of employment, legal troubles) may seem more immediate. High-functioning alcoholics face more insidious risks, such as long-term health issues, relationship strain and a slow erosion of their emotional well-being.
• Denial and Recognition:
  Denial is a strong force in both types of alcoholism, but it can be even more entrenched in those who are high-functioning. Success in other areas of life can reinforce the belief that their drinking is under control, making it harder to acknowledge a problem or seek help.

Ultimately, “high-functioning” is a deceptive descriptor because the condition is still alcoholism — and it is still damaging. The outward stability only postpones the point at which the person recognizes their need for professional intervention.

Risk Factors for High-Functioning Alcoholism

Alcoholism can affect anyone, regardless of background, education or socioeconomic status. However, certain risk factors can increase the likelihood of developing high-functioning alcoholism:

• Genetics: A family history of alcohol misuse or other substance use disorders increases the risk of any alcohol use disorder, including high-functioning alcoholism. Genetic predisposition can interplay with environmental factors, heightening the vulnerability.
• Culture and Social Norms: In cultures or social circles where drinking is normalized or even celebrated, individuals who can “hold their liquor” without outwardly stumbling may gain social approval. This context can encourage continued heavy drinking while downplaying the need to get help.
• High-Stress Professions: Careers that involve constant pressure, long hours or high-stakes environments (e.g., law, finance, healthcare) can contribute to the development of high-functioning alcoholism. Alcohol might be used as a coping mechanism for workplace stress.
• Co-occurring Mental Health Disorders: Conditions like anxiety, depression or trauma-related disorders can make a person more susceptible to alcohol misuse. When someone discovers that drinking temporarily eases mental health symptoms, they can slip into a pattern of dependence to manage emotional pain.
• Early Exposure: People who begin drinking heavily at a younger age, especially if it’s encouraged or normalized in their environment, can develop problematic habits that persist into adulthood. If these drinking patterns become deeply ingrained, it is easier to function outwardly while still harboring a problematic relationship with alcohol.
• Personal Traits: Certain personality traits, like high achievement orientation, perfectionism or the desire to maintain a flawless outward image, can correlate with high-functioning alcoholism. These individuals are often more driven to conceal weaknesses or vulnerabilities, including problematic alcohol use.

Risks of Being a High-Functioning Alcoholic

Because high-functioning alcoholics can “manage” their everyday lives, the misconception is that they are somehow immune to alcohol’s negative effects. However, a high level of functioning does not diminish the inherent risks, which can grow more severe over time.

• Physical Health Consequences: Chronic excessive alcohol use can lead to a multitude of health issues, including liver disease (cirrhosis, fatty liver), gastrointestinal problems, high blood pressure, heart disease and an increased risk of certain cancers. These risks are not minimized by one’s ability to perform well at work or maintain a steady income.
• Emotional and Mental Health Issues: Alcohol is a depressant that affects brain chemistry. Over time, chronic use or dependence can exacerbate mental health problems like depression, anxiety, mood swings or irritability. Relying on alcohol as a coping strategy can worsen psychological distress and create a cycle that’s difficult to break without professional intervention.
• Relationship Erosion: Even if a high-functioning alcoholic maintains a veneer of stability, close relationships often bear the burden of their alcohol misuse. Partners, children and friends may experience emotional distance, conflict or inconsistent behavior. Trust can deteriorate as promises to reduce drinking are repeatedly broken or concerns are dismissed.
• Increased Tolerance and Dependence: As tolerance grows, a high-functioning alcoholic may escalate their drinking to maintain the same effects. This escalation can heighten dependence and make withdrawal symptoms more intense when they are forced to abstain — for example, during travel, work events without alcohol or any situation where alcohol is unavailable.
• Risky Behaviors: Even if individuals avoid obvious problems like missing work or getting arrested, they may still engage in risky behaviors. Driving under the influence, mixing alcohol with medications or staying up late to drink before a big meeting can eventually lead to accidents, injuries or a sudden crisis that unravels the “high-functioning” illusion.
• Delayed or Avoided Treatment: Because high-functioning alcoholics rarely hit a dramatic “rock bottom,” they often delay seeking help until problems become dire. This delay can have serious medical, financial or interpersonal repercussions, making eventual recovery efforts more complicated.
• Burnout: Maintaining the outward appearance of success while grappling with alcohol dependence is exhausting. Over time, the pressure to keep up the act can lead to burnout, increased drinking and a sudden drop in overall functioning if something goes awry.

Living with an Alcoholic and Avoiding Codependency

Many spouses, significant others, parents and children of high-functioning alcoholics fall into the trap of codependency, in which they protect the alcoholic from the consequences of the disease. Codependents sacrifice their own needs to maintain a facade of normalcy at home. Typical codependent behaviors include:

• Making excuses for the alcoholic’s actions: “I’m afraid she’s too sick to come to your party,” or “He’s really not that mean all the time, he’s just under a lot of stress.”
• Covering the alcoholic’s expenses: paying legal fees, traffic tickets or fines that the alcoholic incurred.
• Hiding the consequences of heavy drinking: cleaning up messes or washing soiled clothes before the alcoholic is sober enough to see them.
• Trying to manipulate the alcoholic into changing: making emotional threats or using passive-aggressive behavior to make the alcoholic feel guilty.
• Trying to control the alcoholic’s drinking: keeping a large supply of alcohol at home or drinking with the alcoholic to keep an eye on him.
• Pretending that your own needs don’t matter: denying that the alcoholic has hurt you emotionally or physically or that you weren’t disappointed by their failure to meet commitments.

Consciously or unconsciously, the codependent may help the alcoholic to continue drinking to maintain the status quo. Many high-functioning alcoholics earn a good living and can support their families while continuing to drink. Intervening in the addictive behavior may be seen as a threat to the family’s financial security — even if the family must put up with emotional neglect or physical abuse. The U.S. Bureau of Justice Statistics noted that nearly 60% of violent incidents against a domestic partner or family member were committed under the influence of alcohol.

The best cure for codependency is a strong, healthy sense of self. Individual therapy, combined with marriage or family counseling, can strengthen your self-esteem and help you build a healthy, sober relationship.

Seeking Support From Others

If someone close to you is a high-functioning alcoholic, it’s just as important to seek support for yourself as it is to get help for your loved one. You likely have questions about how to deal with an alcoholic or how to help an alcoholic. Self-help organizations, church groups, and 12-step programs like Al-Anon and Alateen offer advice, hope and encouragement to people involved with functioning alcoholics.

Alcoholism affects everyone in a household— not just the individual who drinks. Alcohol abuse increases the risk of physical and emotional violence, as well as substance abuse in other family members. An addiction therapist can help you find positive ways to deal with the stress of living with a functional alcoholic.

Holding an Intervention

If the consequences of high-functioning alcoholism have become overwhelming, and your loved one refuses to seek help for alcohol abuse, it could be time to plan an intervention. An intervention is a planned meeting in which the concerned parties confront the alcoholic about their behavior.

The goals of an intervention include:

• Getting the alcoholic to see how drinking has harmed them and their loved ones
• Presenting the alcoholic with a plan for recovery
• Proposing consequences if the alcoholic refuses to seek treatment
• Helping the alcoholic take the right steps to enter treatment

The participants in an intervention could include the alcoholic’s spouse or partner, children, parents, friends, coworkers, employer, friends and other individuals who have been affected. A substance abuse counselor, family therapist or spiritual advisor may also attend to provide an objective presence and keep the agenda on track.

Although an intervention can take many forms, many of these meetings open with each participant stating how the alcoholic’s behavior has harmed or disappointed them. The alcoholic is then presented with a plan of care, including a proposal of consequences if they decide to refuse. For instance, the alcoholic may be denied visitation rights or may be faced with a marital separation if he decides not to seek help. An alcoholic in denial may become extremely manipulative, tearful, angry or hostile when faced with the need for alcohol treatment. An experienced intervention specialist can help the participants prepare for these reactions so they can respond effectively.

How to Help a High-Functioning Alcoholic

Recognizing the signs of a high-functioning alcoholic is only part of the equation. The next step — helping them navigate treatment and recovery — can be challenging. High-functioning alcoholics often rely on denial or minimization of their drinking problem. Nonetheless, there are constructive ways to approach the situation:

• Start the Conversation Carefully: Approach the topic with empathy and understanding. Confrontational or accusatory statements often prompt denial or anger. Instead, express concern for their well-being: “I’ve noticed you’ve been more stressed lately. How are you doing? Are you okay?” While you may eventually need to highlight specific concerns about alcohol, opening with support and genuine care can make the conversation more productive.
• Provide Specific Examples: If you do broach the subject of alcohol use, be prepared to offer concrete instances that illustrate your concerns. This might be pointing out a time they were hungover and unable to fully engage in an important event, or mentioning changes in mood or behavior after they’ve been drinking. Specifics can help dismantle denial.
• Encourage Professional Help: Professional treatment can range from outpatient therapy and support groups to medically supervised detox and inpatient rehabilitation. A thorough evaluation by a medical professional or addiction specialist can determine the best course of action. High-functioning alcoholics may prefer initially less disruptive treatment options, such as outpatient programs, provided that these are clinically appropriate.
• Suggest Support Groups: Groups like Alcoholics Anonymous (AA) or SMART Recovery offer a sense of community, structure and accountability. High-functioning alcoholics sometimes resist these forums out of pride or because they believe their problem isn’t “that severe.” Emphasize that these groups are for anyone struggling with alcohol use, regardless of how successful they may appear on the outside.
• Offer Resources and Information: Arm yourself with knowledge about alcohol use disorder, including local treatment centers, therapists specializing in addiction and online resources. Providing factual information can help someone understand the severity of their situation and the options available to them.
• Set Boundaries: If you’re close to someone who is a high-functioning alcoholic, you must protect your own well-being. This might mean avoiding situations where you feel pressured or anxious about their behavior. If they become verbally or emotionally abusive when drinking, establish clear boundaries about what is acceptable.
• Encourage Healthy Coping Strategies: Many high-functioning alcoholics use drinking to cope with stress or emotional difficulties. Consider suggesting healthier ways to relieve stress, such as exercise, meditation, hobbies or therapy. Introducing alternative coping mechanisms can reduce reliance on alcohol.
• Be Prepared for Resistance: It’s common for high-functioning alcoholics to argue that their drinking is not problematic, especially if there are no significant outward consequences yet. They may point to their career success, good physical health or fulfilling relationships as proof that everything is fine. Anticipate some resistance and maintain a consistent, supportive stance.
• Follow Up: One conversation is rarely enough to address alcoholism. Periodically check in on how they’re doing, whether they’ve taken any steps to seek help and whether they need any support. Consistency demonstrates genuine care and can eventually break through denial.

Alcohol Treatment with Dr. Wandler

Getting the Help You Need

When you’re living with a high-functioning alcoholic, your own health is at stake as well as the welfare of your loved one. By getting help for your loved one, you may be able to avoid further consequences of alcoholism and build a healthier future for your family.

Treatment programs at The Recovery Village include a full spectrum of alcohol recovery services, from alcohol detox to rehab, aftercare and sober housing. When you’re ready to seek help, or if you have questions about how to live with an alcoholic, we’re here for you. Contact us today to learn more about our treatment options.