How to Know if Someone Has Functional Alcoholism?

High-functioning alcoholism is a hidden but serious issue affecting many Nevadans who appear to lead successful, stable lives. Despite fulfilling work, family, and social responsibilities, 11.8% of adults in Nevada reported alcohol use disorder (AUD) in the past year, according to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2022), a rate higher than the national average. 

High-functioning alcoholism goes unrecognized, as those affected do not exhibit the stereotypical signs of addiction. Understanding its signs, clinical criteria, long-term risks, and available treatment options is key to identifying the problem early and supporting recovery.

What Is Functional Alcoholism?

Functional alcoholism refers to a form of alcohol use disorder (AUD) where a person continues to meet personal, professional, and social responsibilities while engaging in problematic drinking. These individuals appear stable and prosperous on the outside but rely on alcohol in ways that are harmful to their physical and mental health. Their ability to “function” masks the severity of their addiction, delaying diagnosis and treatment.

How Can Someone Be an Alcoholic and Still Function Normally?

Someone can be an alcoholic and still function usually in many areas of life, at least on the surface. These individuals, referred to as high-functioning alcoholics, maintain jobs, raise children, pay bills on time, and even appear socially active and successful. However, this outward normalcy masks serious underlying problems with alcohol use.

Functioning alcoholics don’t fit the stereotypical image of someone with a drinking problem. They are well-educated professionals, caregivers, or community leaders. Because they keep up appearances and avoid obvious consequences like job loss or legal issues, their alcohol use disorder (AUD) goes unnoticed by loved ones and even by themselves.

These individuals drink heavily in private or at socially acceptable times, experience intense cravings, and develop physical dependence. They hide how much they drink, struggle with guilt or shame, and use alcohol to manage stress, anxiety, or unresolved trauma. 

Even without obvious life disruptions, their behavior still meets clinical criteria for alcohol use disorder (AUD), especially if they show signs like compulsive use, increased tolerance, failed attempts to cut back, or continued drinking despite adverse consequences. Left untreated, high-functioning alcoholism leads to more severe addiction, damaging mental health, relationships, and long-term physical well-being.

What Are the Diagnostic Criteria for Alcohol Use Disorder?

The diagnostic criteria for alcohol use disorder (AUD), according to the DSM-5, focus on a pattern of problematic drinking within the past year. High-functioning individuals still meet these criteria even if they maintain jobs, relationships, or daily responsibilities.

A person has AUD if they meet at least two of the following:

• Inability to limit alcohol use
• Strong cravings for alcohol
• Continued use despite negative consequences
• Developing tolerance (needing more alcohol for the same effect)
• Withdrawal symptoms when not drinking

What Are the Signs of High-Functioning Alcoholism?

The signs of high-functioning alcoholism include subtle yet concerning behavioral, emotional, and physical patterns. These individuals do not face obvious external consequences, making the disorder more challenging to detect. Many continue excelling at work or home, which reinforces denial and delays seeking help. However, their drinking still reflects loss of control and psychological dependence.

Behavioral Indicators

The behavioral indicators of functional alcoholics are as follows:

• Drinking in secret: High-functioning alcoholics hide alcohol around the home or workplace, sneak drinks before social events, or drink alone to avoid judgment.
• Blackouts or memory lapses: Functional alcoholics do not recall conversations or actions after drinking, even if they seemed coherent at the time.
• Justifying drinking: Common excuses include “I earned it,” “It helps me relax,” or “It’s just a glass of wine,” used to normalize excessive consumption.
• Drinking alone or at inappropriate times: Regular alcohol use during lunch breaks, commutes, or early mornings signals a deeper issue, even if responsibilities are still met.
• Excelling at work or home despite heavy drinking: They overcompensate with high performance or productivity, masking their dependence on alcohol.
• Rationalizing use by comparison: Saying “I’m not like those people” or comparing themselves to someone with severe addiction keeps them from acknowledging their own problem.
• Denial of a problem due to lack of ‘rock bottom’ moments: Because they haven’t lost a job, crashed a car, or been hospitalized, they insist they don’t have a drinking issue.

Emotional and Physical Signs

The emotional and physical signs of functional alcoholics are as follows:

• Mood swings or irritability when not drinking: They become restless, anxious, or short-tempered during periods of sobriety, especially when drinking is delayed or discouraged.
• Guilt or shame about drinking habits: Internally, many struggle with regret, secrecy, or self-criticism after drinking episodes, even if they don’t express it outwardly.
• Neglecting self-care or sleep while appearing outwardly stable: Late nights, hangovers, or disrupted routines take a toll, even if personal appearance or routines seem intact.
• Cravings in stressful or celebratory situations: They rely on alcohol to manage anxiety, boost confidence, or “celebrate” success, leading to regular and compulsive use.

What Is Functional Tolerance?

Functional tolerance occurs when someone’s body adapts to alcohol’s effects, allowing them to consume large amounts without appearing intoxicated. This makes it easier to hide a problem while increasing the risk of physical dependence and liver damage.

Why Is Functional Tolerance Misleading?

Functional tolerance is misleading because it allows individuals to consume large amounts of alcohol while still appearing sober or in control. They speak clearly, manage responsibilities, and perform daily tasks without showing obvious signs of intoxication. This creates a false sense of safety for both the individual and those around them.

However, the absence of outward symptoms does not mean their body is unharmed. Internally, alcohol is still damaging critical organs, especially the liver, brain, and heart. Over time, this silent strain leads to serious health issues like liver disease, cognitive decline, and cardiovascular problems. Just because someone doesn’t look drunk doesn’t mean they are free from harm. Functional tolerance masks the severity of alcohol misuse, delaying intervention and treatment.

What Are the Long-Term Risks of High-Functioning Alcoholism?

The long-term risks of high-functioning alcoholism include serious physical, psychological, and cognitive consequences. Many individuals delay seeking help because they haven’t yet faced dramatic life disruptions, but damage is still occurring internally. Left untreated, these risks worsen and become life-threatening.

Long-term risks of high-functioning alcoholism are as follows:

• Liver disease: Chronic alcohol use strains the liver, increasing the risk of fatty liver, hepatitis, and cirrhosis. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol-related liver disease accounts for nearly 30% of liver transplants in the U.S.
• Heart problems: Long-term drinking raises blood pressure, contributes to irregular heart rhythms, and increases the risk of stroke or cardiomyopathy. A study in The Lancet et al. 2018 found that consuming more than 100 grams of alcohol per week (about 7 standard drinks) was associated with higher cardiovascular mortality.
• Depression and anxiety: Alcohol alters brain chemistry, worsening symptoms of depression or anxiety over time. Many high-functioning alcoholics use alcohol to self-medicate, creating a cycle of dependence and deteriorating mental health.
• Cognitive decline: Prolonged alcohol misuse impairs memory, attention, and executive function. Over time, this leads to alcohol-related dementia or Wernicke-Korsakoff syndrome, particularly in older adults.
• Sleep disorders: While alcohol initially induces drowsiness, it disrupts REM sleep cycles, leading to insomnia and poor sleep quality, which compounds mood and cognitive issues.
• Increased risk of accidents or overdose: Even high-functioning individuals are more prone to alcohol-related injuries, motor vehicle accidents, and overdose, especially when alcohol is mixed with other substances like benzodiazepines or opioids.

How Can You Tell If You or a Loved One Needs Help?

To know if you or a loved one needs help, look beyond how well things appear on the surface. If alcohol use is compulsive, secretive, or causing emotional or physical strain, even without obvious external consequences, it is time to seek professional support.

You or someone close to you might benefit from help if:

• Attempts to cut back on drinking have failed
• Drinking is used to cope with stress or emotions
• Health issues related to drinking have started to appear
• You feel guilty about drinking or hide it from others
• Cravings or preoccupation with alcohol occur regularly
• Relationships are strained due to drinking habits
• You drink more than intended or lose control once you start
• Daily functioning feels dependent on alcohol use

What Are the Treatment Options in Nevada for High-Functioning Alcoholism?

The treatment options in Nevada for high-functioning alcoholism include outpatient care, partial hospitalization, and residential rehab. In Nevada, these programs are tailored to meet the unique needs of individuals who appear to function normally but struggle privately with alcohol dependence.

The treatment options for high-functioning alcoholism are as follows:

Medical Detox (When Needed for Safe Withdrawal)

For clients with physical dependence on alcohol, rehabs in Nevada offer medically supervised detox in a private, supportive setting. The professional monitors vital signs, manages withdrawal symptoms, and ensures a safe transition into therapeutic care. Detox is the first step before entering residential or outpatient treatment.

Outpatient Programs (OP/IOP)

The outpatient programs are ideal for individuals who want to maintain work or family responsibilities while receiving structured support. Clients attend therapy several times per week, including individual counseling, group therapy, and dual diagnosis care to address underlying mental health issues like anxiety or trauma.

Residential Rehab

For those needing more intensive support, the residential program offers round-the-clock care in a serene and private setting. Clients benefit from personalized treatment plans, holistic therapies (yoga, nutrition, acupuncture), and a calm environment designed to support emotional healing and long-term recovery. This setting is especially beneficial when home life contributes to stress or relapse.

What Therapies Are Used to Treat High-Functioning Alcoholism?

The therapies used to treat high-functioning alcoholism include behavioral counseling, family involvement, experiential methods, and, when appropriate, medication. These approaches target the psychological, emotional, and biological factors that maintain alcohol use despite outward functionality.

The following evidence-based and holistic therapies are commonly used:

Family Therapy

Family dynamics play a hidden role in maintaining alcohol use. Structured family therapy sessions help loved ones set boundaries, communicate more effectively, and break enabling patterns, enhancing recovery outcomes.

Pharmacological Therapy

In addition to anti-craving medications, psychiatric medications are used to treat co-occurring conditions like anxiety, depression, or trauma, common underlying factors in high-functioning alcoholism. Pharmacological therapy helps individuals with high-functioning alcoholism recover safely.

Experiential Therapy

Experiential approaches like art therapy, music, movement, or nature-based sessions provide emotional release and self-discovery. These experiential therapies include sound bath therapy, EMDR, and cold plunge therapy to help clients process unresolved trauma or stress in non-verbal ways.

Psychotherapy 

One-on-one sessions of psychotherapy with a licensed therapist allow individuals to explore underlying emotional drivers of alcohol use, build self-awareness, and develop long-term coping skills tailored to their life challenges.

What Happens If a Person with High Functional Alcoholism is Left Untreated?

If a person with functional alcoholism is left untreated, the condition worsens over time. What begins as manageable or hidden drinking escalates into more severe consequences. The brain and body continue to suffer silently, increasing the risk of liver damage, heart issues, and cognitive decline.

Delaying treatment leads to emotional instability, strained relationships, and diminished work performance. Eventually, even the “functioning” aspect breaks down, leading to job loss, family conflict, hospitalization, legal issues, or co-occurring mental health disorders like depression or anxiety. 

What If a Person with High Functional Alcoholism Refuses Help?

If someone with high-functioning alcoholism refuses help, it’s essential to take action while protecting your own well-being. Consider staging a professional intervention to help them see the impact of their drinking. Set firm boundaries, such as removing alcohol from the home or refusing to excuse their behavior. 

Avoid enabling them by not covering for them at work or with family. Choose calm, non-confrontational moments to talk about your concerns. Most importantly, seek support for yourself through individual therapy or groups like Al-Anon, so you maintain your mental health while encouraging your loved one toward recovery.