One of the hardest things to accept about an alcohol use disorder (AUD) is how everything can appear “normal” and someone can still have a serious problem.

After all, drinking is both legal and socially acceptable. People enjoy wine tours, craft beer festivals, and liquor pairings with gourmet appetizers. We pop a bottle of champagne to celebrate new babies, promotions, and other momentous occasions. Alcohol is a booming industry in the United States, generating approximately 210 billion dollars in sales annually.

For someone struggling with addiction, appearances are often deceiving. Just because a person isn’t drunk all the time or doesn’t experience the stereotypical life challenges of an addict doesn’t mean his or her condition is less real. In a world where many people openly drink without any problems, a functioning alcoholic walks a delicate high wire.

Myths About High-Functioning Alcoholism

According to 2015 statistics from the National Institute on Alcohol and Alcohol Abuse, an estimated 15 million adults over 18 had AUD.

There are many myths about addiction that often make it difficult for people to release stigmas regarding substance abuse or AUD. These myths pose challenges for someone needing rehabilitation treatment or ongoing recovery support from family and friends.

Conversely, when someone seems to be functioning well based on society’s perceptions, there may be a shadow hiding the real truth.

• An individual working a “good” job can’t be an alcoholic. A dentist who drinks vodka in his water bottle while seeing patients, a restaurateur who has nightly post-shift drinks with staff members, or a company executive who frequently treats clients to a “liquid lunch” are more common than most people believe. Alcoholism isn’t limited to a particular segment of class or economic structure.
• He or she is a loving and attentive parent/partner. This may be accurate. After all, not every person is angry, depressed, or obnoxious while drinking. Some people become more relaxed and less reactionary. Personality changes often depend on the type of alcohol, the number of drinks, and the duration of abuse.
• Alcohol isn’t a drug. The psychoactive effects of alcohol begin with just 0.05 percent of blood alcohol content—usually one or two drinks for the average adult. Once alcohol is in the bloodstream, it affects specific areas of the brain that react to chemical modification, such as the pleasure center and the amygdala. Over time, alcohol is the only substance that can stimulate these areas—an artificial enhancement characteristic of physical, behavioral, and psychological addiction.
• He or she never has a hangover. When a chemical is introduced to the body on a regular basis, a strong tolerance develops. This can prevent the development of hangover like a casual drinker would experience.
• There aren’t any problems, so there’s no reason to drink. Here again, stereotypes fuel certain myths. Remember: some people drink to celebrate special occasions as much as others might drown their proverbial sorrows.

To dispel these and other myths, the National Institutes of Health identifies people in the high-functioning subtype this way:

• They often have a stable job and supportive family.
• They are usually middle-aged.
• They hold an advanced level of education.
• They often have an individual history of depression or anxiety.
• They also may have a family history of addiction, whether alcoholism or substance abuse.

Functioning Alcoholism Warning Signs

No one wants to be the judge or jury of a friend or loved one. However, recognizing when someone may be in crisis and need help is a vital first assessment to further action.

Perhaps you’ve noticed a pattern of behavior for years. Maybe certain things, such as financial management or personal care habits, are starting to slip. Here are other critical symptoms of AUD apparent in many high-functioning individuals:

• Quantity. WebMD classifies heavy drinking as more than three drinks daily or seven weekly for women. For men, heavy drinking is four drinks daily or 14 per week.
• Habit. Someone suffering from AUD may drink alone, in the morning, during the workday, or when others aren’t imbibing.
• Denial. When someone doesn’t see AUD for what it is, he or she may lie about consumption, or justify it as “no big deal” to have a beer or two each night after work. He or she may also get angry when asked about drinking, hide alcohol to avoid detection, or make excuses for drinking-related behavior.
• Choice. If a friend or loved one chooses to drink instead of eat, socialize, or care for himself, AUD is likely the cause.
• Jokes. Some people may suspect they have a drinking problem but because of fear or denial, simply joke about it or pass it off in other nonchalant ways.
• Health. If you notice a friend or loved one’s health declining, or spot key symptoms of drunkenness for the first time such as slurred speech, impaired mobility, and cognitive or behavioral changes, it might be time to speak up.
• Problems. These vary considerably based on the individual. Relatable complications include a DUI offense, blackouts, loss of relationships due to drinking but continuing to do so, or shirking responsibilities.

What to Do

Although it may be a difficult conversation, there’s no point in waiting to address someone’s drinking problem if you feel it jeopardizes his or her health or compromises the safety of others. MedlinePlus has a guide to help you know how and when to talk with a medical professional and steps you can take to start the process with your friend or loved one.

Also, please review our site more thoroughly for additional resources. Our blog and services pages provide in-depth information to help you understand addiction and what options are available for healing.

By Tracey L. Kelley