Almost everyone in America has had a drink at least once in their lifetime. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), more than 85% of people over age 18 had at least one drink in their lifetime.
Since alcohol seems to permeate American culture, it’s no wonder that the drug is one of the most commonly abused substances in the country. With the frequency of alcohol misuse and the seeming acceptance of it in our society, the idea of a high-functioning alcoholic is commonly seen in media and pop culture.
Can someone successfully manage an alcohol-related vice and their everyday life and duties? Is there such a thing as a high-functioning alcoholic?
Learn more about the nature of alcoholism and its impact on your life.
An alcoholic is a common term that describes someone with an alcohol use disorder (AUD). An AUD is an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), for someone who drinks alcohol to the point that it causes problems in their lives. AUDs are broken into three categories based on severity: mild, moderate, and severe.
The DSM-5 lists 11 factors that can help doctors and clinicians diagnose a substance use problem. These factors include things like using alcohol in a way that’s dangerous, growing tolerance, or experiencing withdrawal symptoms. If you experience two or three of these problems, you are diagnosed with a mild substance use disorder, four to five is a moderate SUD, and six or more is a severe substance use problem.
Alcohol use disorders can involve both chemical dependence and addiction. Chemical dependence has to do with your brain’s chemical messengers in the central nervous system. When your brain chemistry adapts to a substance like alcohol, it can cause uncomfortable withdrawal when you try to quit. Your brain chemistry relies on it. People that become chemically dependent on alcohol often continue to use alcohol just to feel normal.
Addiction is a disease that affects the reward center of the brain. Alcohol affects some of the same brain chemicals tied to reward, motivation, and positive feelings. If your brain starts to associate alcohol with positive feelings in the face of challenges, stress, or other mental health issues, it will encourage you to drink through compulsions and cravings. Addiction and chemical dependency often go hand in hand. When you try to quit, withdrawal symptoms combine with powerful compulsions to use, and it’s extremely difficult to resist relapse. This is why substance use disorders often get out of control.
When people refer to high functioning alcoholism, they are usually talking about a person who struggles with alcohol misuse but can still function in society. It conjures up pop culture images of the hard-working professionals with a vice that they deal with after hours. However, the idea of high-functioning alcoholism is largely a myth.
Of course, there are people with less severe alcohol use disorders, but describing them as high-functioning alcoholics may not accurately describe the disease of alcoholism. It may lead you to believe you can be an alcoholic with a degree of control over your alcoholism. However, addiction is a progressive disease, which means that it will slowly get worse over time if it isn’t addressed. A high-functioning alcoholic could be someone with mild alcohol use disorder. But even mild cases can grow into moderate and severe problems if they’re left unaddressed.
There is still a lot we don’t know about how addiction works in the brain, but many people have some similar experiences when dealing with it. Addiction is often tied to mental health problems, such as depression and anxiety disorders. In fact, about half of all the people who seek treatment for substance use disorders also have another mental health issue, and vice versa. Those who don’t may deal with stress, developmental issues, or genetic predispositions to addiction.
Alcoholism also tends to worsen issues in your life. Alcohol addiction sometimes begins with something called self-medication, which is when a person uses alcohol to mask or numb problems like depression.
Social drinking becomes drinking alone at odd hours and in the middle of responsibilities. However, self-medication with alcohol often exacerbates problems. Drinking too much can threaten your health. It can also put a strain on your relationships and jeopardize your career. On top of the problems you were dealing with, now you’re dealing with problems that were caused by alcohol.
The problem is that your brain has learned to deal with negative emotions with alcohol. You may get caught in a cycle in which problems created by alcohol make you crave alcohol more often. Plus, there are chemical factors at play. Chemical dependence causes tolerance, and you’ll need to drink more to achieve the same effects that you used to experience with fewer drinks. As you need more alcohol to satiate your physical needs, your psychological and emotional needs will also rely on drinking more.
Even a functioning alcoholic may quickly progress to experiencing a severe substance use disorder. Addiction has the uncanny ability to take over multiple aspects of your life, including your health, relationships, finances, and legal standing. Recognizing a growing substance use problem and addressing it quickly may help you avoid some of the worst consequences of addiction.
Someone who considers themself a high-functioning alcoholic may think they have their alcohol use under control. But a closer look at their life may show that alcohol is controlling them. Alcohol use problems often progress from recreational social use to drinking in isolation just to feel normal. When this happens, alcohol is more like self-medication than a recreational substance.
As you continue to use alcohol in this way, your tolerance for it will grow. You’ll need to drink more to feel the same effects that you did before. This means you have to spend more time throughout the day managing your addiction.
As you start to rely on alcohol, you may feel uncomfortable withdrawal symptoms like tremors, anxiety, agitation, and insomnia when you haven’t had anything to drink in a while. When you drink at night, you may feel withdrawal symptoms in the morning. This can lead to drinking more at odd hours and throughout the day. You spend more time intoxicated or feeling withdrawal symptoms.
Even if you feel you have everything under control, you’re having to build your schedule around making time for alcohol. If you don’t drink when you need to, you’ll experience withdrawal. If you drink before or during other responsibilities, you may struggle to fulfill your obligations. Alcoholism often leads to strain relationships, trouble at work or school, and health issues as you struggle to manage your addiction.
In a sense, there is no such thing as a high-functioning alcoholic. Instead, a person with a mild alcohol use problem may just be in the early stages of a chronic and progressive disease. However, alcoholism can be treated and managed. Many people with alcohol use disorder seek treatment and enter long-term recovery.
Hartney, E. (2020, November 13). The 11 Official Criteria for Addiction. from https://www.verywellmind.com/what-are-the-official-criteria-for-addiction-22493
National Institute on Drug Abuse. (2020, July 24). Comorbidity: Substance Use Disorders and Other Mental Illnesses DrugFacts. from https://www.drugabuse.gov/publications/drugfacts/comorbidity-substance-use-disorders-other-mental-illnesses
National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Facts and Statistics. from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
National Institute on Drug Abuse. (2019, November). 6: Definition of tolerance. from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/6-definition-tolerance
National Institute on Drug Abuse. (2019, November). 8: Definition of dependence. from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/8-definition-dependence