Functional Alcoholism: What Does It Mean to Be a ‘Functioning Alcoholic’?

A lot of people in the U.S. drink alcohol. In a 2024 national survey, over 60% of people ages 12 and older reported drinking alcohol within the past year. But not everyone who drinks alcohol has a “drinking problem.” About 1 in 10 people met the criteria for alcohol use disorder (AUD) within the past year.

Some people with AUD can be considered “functional alcoholics.” But what does it really mean to experience functional alcoholism or to have a functional tolerance? 

Is there such a thing as a ‘functioning alcoholic’?

While there are specific criteria to diagnose AUD, there’s less consensus about what exactly it means to be a “functioning alcoholic.” In reality, the term is subjective and doesn’t hold much clinical weight. 

In general, functional alcoholism describes someone who appears to be able to manage in many areas of their life despite having AUD. They may be able to go to work, keep up at home, and take care of their families. Someone with functional alcoholism may appear to others like they’re keeping up with their responsibilities. The reality, though, is that they may be dealing with a lot of inner turmoil because of their drinking. 

What are the signs of a ‘functional alcoholic’?

Someone with functional alcoholism may recognize that they have a problem. But they may also deny that they have an issue with alcohol. Close friends may notice the signs first. 

Signs of a “functioning alcoholic” can include:

• “Losing control” or blacking out (memory gap) while drinking

• Hiding or lying about drinking

• Making promises to cut back or quit drinking 

• Experiencing conflict with family, friends, or others because of drinking

• Having frequent problems at work or school

• Lacking or losing interest in other activities or hobbies

• Giving up important goals

• Facing legal or financial issues because of alcohol

• Experiencing physical or mental health problems due to drinking

Do you have to drink every day to be considered an ‘alcoholic’?

No, you don’t have to drink every day to have an alcohol use disorder. Like other substance use disorders, AUD isn’t only defined by how much or how often you drink. It’s also determined by the nature of your relationship with alcohol and how it impacts your physical and mental health. 

There are many people who have AUD but don’t drink daily. Some people who binge drink may go days or weeks without drinking and then drink to excess. 

You can have AUD if you drink every day, once a week, or even once a month. You may have AUD if you’re: 

• Drinking more than the recommended limits for moderate drinking (more than 2 drinks per day for men and 1 drink per day for women) 

• Having problems in your life because of alcohol

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When does a functional alcoholic become someone with an alcohol use disorder?

People with functioning alcoholism have AUD, which is an official diagnosis that a healthcare professional can make based on specific criteria. But functional alcoholism doesn’t have the same clear criteria as AUD. It’s more of a subjective interpretation of how someone appears to be functioning, or managing their use of and relationship to alcohol. 

Someone with functional alcoholism may appear to have their drinking under control. But in reality their drinking causes problems in their lives. They meet the criteria for AUD, even though they may hide their problems from others.

Signs of AUD include:

• Using more alcohol over time

• Not being able to cut back or stop drinking, despite trying to quit

• Giving up activities or hobbies that you once enjoyed

• Continuing to drink even though you can’t keep up with responsibilities at work, home, or school

• Continuing to drink even though alcohol causes relationship or health problems 

• Experiencing strong urges to drink

• Spending significant time getting, drinking, or recovering from alcohol

• Drinking alcohol in dangerous settings, like drinking and driving

• Having a high alcohol tolerance

• Experiencing alcohol withdrawal

If you experience at least two of the symptoms listed above, then you may have AUD. Diagnosing AUD starts with a screening and evaluation. A mental health or medical professional can do this. This might be a counselor, psychologist, or doctor. 

What are the consequences of living with a functional level of alcoholism?

Someone with functional alcoholism may be able to hide their problems with alcohol, but they still experience negative consequences related to their drinking. There’s really no amount of alcohol that’s safe to drink. And misusing alcohol over the long term comes with serious risks to your health and well-being. 

Some of the consequences of functional alcoholism include:

• Legal and financial issues, such as a DWI or DUI (drunk driving)

• Poor performance at work or school

• Deteriorated relationships with family and friends

• Increased risk of health conditions, including high blood pressure, heart disease, liver damage, certain types of cancer, weakened immune system, and alcohol-related dementia 

• Mental health issues, including depression, anxiety disorders, and mood disruptions

How to get help if you think you have a problem with alcohol

Treatment for AUD can include a combination of medications, therapy, and self-help groups. 

Detoxing

Alcohol withdrawal can be life-threatening. This is why it’s important to get professional help to manage withdrawal symptoms and safely detox. But treatment for AUD doesn’t stop with detox.

Therapy

Behavioral therapies can help treat AUD. Examples are cognitive behavioral therapy (CBT) and motivational enhancement therapy — also called motivational interviewing.

These therapies share common aims, like helping you to:

• Cope with triggers

• Set attainable goals

• Strengthen your support system

• Develop tools and strategies to prevent relapse

Medications 

A healthcare professional may prescribe medications to help manage alcohol withdrawal symptoms and cravings. They may also recommend medication-assisted treatment (MAT), which combines medication and therapy.

Medications to treat alcohol use disorder can include:

• Disulfiram (Antabuse): This stops the breakdown of alcohol and causes unpleasant side effects if you drink after taking it.

• Acamprosate (Campral): This lowers your desire to drink and can help you to avoid drinking.

• Naltrexone (Vivitrol, ReVia): This reduces urges to drink alcohol and can help prevent relapse.

Self-help groups

Self-help groups are free support groups for anyone recovering from alcoholism. Many are peer-led and available both in-person and online. The most popular support groups are:

• Alcoholics Anonymous (AA): AA encourages members to acknowledge their powerlessness over alcohol, connect with a higher power, and work through the 12 steps.

• SMART Recovery: This is a scientific-based group that teaches skills to manage cravings and prevent relapse.

Why trust our experts?

Written by:

Emily Guarnotta, PsyD

Emily Guarnotta, PsyD, is a licensed clinical psychologist and certified perinatal mental health professional with over 10 years of clinical experience.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Farzon A. Nahvi, MD

Farzon Nahvi, MD, is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works at Concord Hospital in Concord, New Hampshire, and teaches at the Geisel School of Medicine at Dartmouth.

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