What Is a "Functioning Alcoholic"?
Medically reviewed by Kashif J. Piracha, MD
The term "functioning alcoholic" is not a medical term. Instead, it is an outdated term that was used to describe a person with alcohol use disorder (AUD) who presents as though their alcohol use has no adverse impact on their life or the lives of those around them. "Functioning" is subjective and limiting when describing a person living with alcohol use disorder.
In this article, learn more about why the term "functioning alcoholic" is outdated and the impact of living with untreated alcohol use disorder.
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Do People With Alcohol Use Disorder Drink Every Day?
The way people with alcohol use disorder present in their day-to-day lives varies significantly. Media portrayal of people with alcohol use disorder is often stereotypical and does not accurately reflect the complexity of alcoholism as a disease.
People with alcohol use disorder are dependent on alcohol, but that does not mean that they drink every day.
A person only has to meet two of the below criteria to be diagnosed with AUD:
Be mentally preoccupied with their next drink
Develop an increased tolerance for alcohol
Drink more, or longer, than intended
Experience withdrawal symptoms when drinking less
Feel depressed or anxious as a result of drinking
Injure themselves as a consequence of drinking
Spend a lot of time drinking or being sick or hungover from drinking
Struggle cutting back or stopping drinking
These criteria are often internal struggles, not observable to others. Someone can live with alcohol use disorder without anyone else noticing.
Signs of Alcohol Use Disorder
Below are some signs that you or someone you love may be living with alcohol use disorder. These signs don't always affect a person's ability to carry out their day-to-day responsibilities.
Drinking Heavily and Excessively
One sign that someone may have alcohol use disorder is that they consume excessive amounts of alcohol. This can look like binge drinking (drinking a lot over a short period) or heavy drinking (drinking a lot over a more extended period).
Both binge drinking and heavy drinking patterns increase a person's risk of AUD and are common behaviors among people with AUD.
Drinking Alone, Secretly, or at Unconventional Times
Drinking alone or being secretive about drinking can be another sign of alcohol use disorder. Drinking alcohol at unconventional times—such as early in the day or at gatherings where nobody else is drinking—is another hallmark of this disease.
These behaviors are potential signs that a person is unable to control their cravings for alcohol or they're trying to resolve withdrawal symptoms by drinking, both of which are symptoms of AUD.
Justifying Drinking as Being a Normal Part of Life
Sometimes, people with alcohol use disorder don't recognize their drinking is an issue, especially if they meet their work and home life responsibilities despite their alcohol dependence. As such, they may justify their drinking as a normal part of life—even though it isn't.
Trouble Quitting Drinking
Someone with alcohol use disorder may struggle to cut back on drinking or quit, either when trying to do so themselves or when asked by others to try.
The refusal to abstain can become more apparent in certain situations. This includes times when many people give up alcohol, such as "dry January" or the period of fasting and penitence in the Christian calendar leading up to Easter known as Lent. It may also cause an individual to refuse to travel to areas where alcohol access may be limited.
Frequent Performance Issues at Work or Other Functions
Issues with work, school, and relationships are common among people living with AUD. However, these issues are not always apparent to outsiders. These issues can be insidious and increase as a person becomes more dependent on alcohol. Over time, these minor signs can snowball into more significant issues.
Seek Help
If you or someone you know is struggling with excessive alcohol use, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
Risks and Impact of Living With Alcohol Use Disorder
Being able to carry out regular responsibilities with AUD is not the same as being free of the disease. Alcohol use disorder can still have a significant impact on a person's life, even if they appear to be coping from the outside.
Physical and Mental Health
There are long-term health consequences of alcohol abuse, including an increased risk of:
Certain cancers
Digestive problems
Learning and memory problems
Just because a person can still go to work while dependent on alcohol does not mean that they are immune to the health consequences associated with the disease.
Relationships and Social Life
Alcohol use disorder also negatively affects a person's relationships and social life. As a person becomes and remains dependent on alcohol, they can struggle with:
Difficulty maintaining healthy and meaningful connections
Difficulty meeting demands at work and home
Isolation and withdrawal from social activities
Strained relationships with family, friends, and colleagues
How to Cope When a Loved One Has Alcohol Use Disorder
If someone you are close to is living with alcohol use disorder, you may be looking for ways to help them cope with the impacts of their disease on your own life.
An excellent first step is to stop enabling their drinking. For many people, enabling can be second nature. Some ways you may be enabling someone with alcohol use disorder include:
Buying them alcohol
Drinking when they drink
Forgiving risky behaviors
Helping with their responsibilities
Lending them money
Making excuses for their drinking to other people
It can be hard to stop enabling someone you care about once you've recognized it. Try to talk openly to the person about your concerns, and encourage them to seek help from resources like Alcoholics Anonymous (AA).
To cope with your stress, you may want to attend a support group for family and friends of people with alcohol use disorder (such as Al-Anon) or consider therapy.
How to Get Help for Alcohol Use Disorder
Recovering from AUD is possible. The incredibly important first step is to recognize your need for help and move past denial.
Medications
In the United States, there are currently three medications approved to treat AUD. These include:
Naltrexone: A once-daily pill or once-monthly injection that can manage alcohol cravings and reduce heavy drinking
Campral (acamprosate): A valuable medication once someone is already sober to help prevent heavy drinking and, in some cases, manage cravings
Antabuse (disulfiram): A medication that stops alcohol from being broken down by the body, which leads to unpleasant symptoms if the person drinks, thereby encouraging them not to drink
Therapy
Behavioral therapy can help people recovering from AUD. There are multiple types of therapy, and one may work better than others, depending on the individual. Types of therapy for AUD include:
Cognitive behavioral therapy (CBT): A highly researched form of treatment that identifies the relationships between thoughts, feelings, and behaviors about alcohol cravings and triggers. It is also used to treat anxiety and depression, which frequently co-occur with AUD.
Motivational enhancement therapy (MET): This therapy involves working with a person on their ambivalence toward changing their behaviors, such as drinking alcohol. It can be helpful to help a person form a treatment plan and the motivation to work on maintaining sobriety.
Marital and family counseling: Group therapy involving the person with AUD and their family to work on both repairing relationships and finding ways to support one another during recovery.
Brief interventions: Short-term therapy wherein a therapist educates the person with AUD on the risks of their drinking patterns, encourages them to make a change, and helps set recovery goals.
These therapies are available one-on-one or in small groups in an inpatient or outpatient setting. Some people with AUD may attend an inpatient recovery program, in which they stay at a facility for at least 28 days to receive concentrated treatment in a controlled environment.
Self-Help Groups and Counseling
Support groups and counseling services can help treat AUD. The most well-known support group is Alcoholics Anonymous, but there are many other 12-step programs.
Support from other people who struggle with alcohol use disorder is an integral part of recovery, alongside medical treatment.
Summary
"Functioning alcoholic" is an outdated term that in the past was used to describe people with alcohol use disorder who appear to meet their everyday responsibilities. However, alcohol use disorder is diagnosed based on a set of criteria that aren't always seen by others.
Treatment and support for alcohol use are available. Consider speaking to your primary care provider about your concerns or attending a support group as a first step.
Read the original article on Verywell Health.
