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High-Functioning Alcoholism Can Be Hard to Recognize. Here’s What to Know

You probably have a stereotypical image of someone who is an alcoholic. You might picture someone who drinks all the time, rarely has a day without a hangover and often can’t recall what happened the night before. It’s someone who can’t get their drinking under control, even though their life may falling apart.

And yet alcoholism—more accurately called “alcohol use disorder”—falls along a spectrum that ranges from mild to severe. People with severe cases might look like the stereotypical alcoholic. But with people who have mild or moderate alcohol use disorder, the signs might not be so obvious. They pay their bills, hold down good jobs and maintain relationships with family and friends.

“They may be quite skilled at hiding their alcohol use and not fit ‘alcoholic’ stereotypes,” said Travis Chenoweth, a social worker at Banner Behavioral Health Hospital in Scottsdale, Arizona. They may acknowledge that they drink more alcohol than they should but deny that it’s a problem. However, heavy drinking will almost always become a problem over time.

According to the National Institute on Alcohol Abuse and Alcoholism, heavy drinking is:

  • More than four drinks on any day, or more than 14 drinks in a week for men
  • More than three drinks on any day, or more than seven drinks in a week for women

Here are some signs of alcoholism

Alcoholics often hide their drinking. They may:

  • Add alcohol to Gatorade or water bottles
  • Stop at the liquor store when they pick up takeout food
  • Drink before a social event, so their level of drinking there appears normal

They may also:

  • Binge drink (typically, five or more drinks in about two hours for men, or four or more for women)
  • Drink while at work
  • Drink and drive
  • Have bloodshot, watery eyes or shaky hands
  • Minimize the seriousness of alcohol use
  • Avoid eating in restaurants that don’t serve alcohol
  • Have unexplained mood changes or are anxious or irritable

Often, family members, friends and coworkers may notice signs like slurred speech, an unsteady gait or the lack of availability to participate in social activities in the evening, said Marcia Giannotti, a social worker/case manager at Banner Behavioral Health Hospital.

For people with mild or moderate alcohol use disorder, the signs may be more subtle. They may:

  • Joke about alcohol use or alcoholism
  • Need to drink so they can relax or feel confident
  • Drink early in the day or when they are alone
  • Plan not to drink too much but get drunk
  • Deny drinking
  • Be pulled over for driving while intoxicated (DWI)

In many instances, a spouse or partner may use the phrase “high-functioning” to downplay the seriousness of the addiction.

Here’s why high-functioning alcoholism is dangerous

People with mild or moderate alcohol use disorder may perform poorly at work and put their jobs at risk. They may struggle to maintain good relationships with their partners, family members and friends. They are at risk of drinking and driving, using poor judgment with sexual partners and blacking out.

Over the long term, heavy drinking carries health risks. High-functioning alcoholics are more likely to develop some types of cancer, high blood pressure, liver and pancreas problems and memory loss.

“‘High-functioning alcoholism’ is an oxymoron,” said Giannotti. “Alcohol is neurotoxic and inflammatory. It can damage your body in a multitude of ways, and in the long run, alcoholism can be fatal.”

What should you do if you spot the signs of alcoholism?

If you recognize signs of alcoholism in yourself, you should seek help from a psychiatrist, primary care doctor or therapist. Be honest about how much you’re drinking and what symptoms you’re experiencing. “For alcoholics, it is not possible to drink moderately. The safest option is not to drink at all,” Chenoweth said.

If you spot signs of alcoholism in a loved one, encourage them to seek help. You can research available resources in your area where they can connect with support.

You can also find helpful information on these websites:

Here’s how alcoholism can be treated

Treatment for alcoholism can include individual or group therapy, medication to reduce cravings and inpatient rehab programs. People with alcoholism should try to avoid bars, parties and situations where alcohol is served. “People, places and things associated with drinking alcohol are a stronger ‘trigger’ than a craving,” Giannotti said.

You may want to try a support group such as Alcoholics Anonymous, Smart Recovery and  Celebrate Recovery. If your loved one is an alcoholic, you may want to attend an Al-Anon support group. “Community AA meetings remain the most successful relapse prevention option,” Giannotti said. “They are free and available around the world every day of the week.”

The bottom line

People with high-functioning alcoholism may be managing their jobs, finances and relationships, but alcohol use is still causing physical and emotional harm. If you or a loved one are struggling with excessive alcohol use, reach out to Banner Health for support.

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