The Myth of Functional Alcoholism

The 2013 National Survey on Drug Use and Health reports that the majority of Americans aged 12 and older actively drink alcohol, and in the 30 days prior to the study almost a quarter of them binge drank (five or more drinks in a single setting). While most people drink, alcohol does not affect everyone in the same way. People often have different tolerance levels, aftereffects (headaches and hangovers) and intoxication rates. Moreover, certain drinkers have higher genetic susceptibility to alcohol addiction, which environmental factors can exploit. The stereotypical alcoholic is the homeless person on the street, but that particular subtype is the least common, especially among middle-aged alcoholics. A more common subtype is the functional alcoholic, a name that reflects appearances, but not realities.

Definition of a Functional Alcoholic

In 2007, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) published the following data of alcoholism subtypes:

  • Chronic severe subtypes (the stereotypes) make up 9% of US alcoholics
  • Functional alcoholics make up 19.5 percent, intermediate familial 19 percent
  • Young adult subtypes make up approximately half of all alcoholics

Per the study, a functional alcohol is typically middle-aged, well educated and has a stable job and a family. The use of functional in the name refers to the addict’s attempts (often successful) at hiding or covering up the alcohol abuse. The individual typically knows how to keep up appearances, deflect blame for alcohol-related mistakes and create fun, narrative contexts for her intoxication. Functional alcoholics typically have real-world skills that they apply to continue drinking, and some people rationalize away addiction signs based on that person’s success (real or staged) in business, family and life. Any success in a functional alcoholic’s life can also reinforce personal denial about the problem.

Furthermore, family members typically enable the addiction in the following ways:

  • Take blame for the substance abuse and the family member’s inability to stop
  • Make excuses for drunken behavior and failure to fulfill commitment
  • Ignore the problem for fear of reprisal from or conflict with the alcoholic
  • Fear social stigma if the loved one’s addiction becomes known in the community

An alcoholic might give the appearance of being functional, and his family might reinforce the functional narrative with the addict and/or the community, but the reality is that no alcoholic is functional.

The Illusion of Functional Alcoholism

As previously noted, the term “functional” refers to appearances, but, to quote a classic idiom, appearances can be deceiving. If an alcoholic truly were functional, there would be no need for family members to make excuses and enable the behavior, and the addict would not need to cover, deny, justify nor hide. Pretending a problem does not exist will not make it go away nor diminish its effects on the individual and her friends and family.

In reality, the term that best describes alcoholism is actually dysfunctional, which can surface in the following ways:

  • Neurobiological – Hippocampus disruptions, cerebellum impairments, damage to neural nerve endings and changes in the mesolimbic system
  • Memory – Impaired episodic memory, dissociative effects disrupting short-term recall and neuron distortion leading to blackouts
  • Familial – Changes in family dynamics that include major shifts in responsibilities and roles, which might include lying and covering for the abuse
  • Behavioral – Increased high-risk conduct like drunk driving and aggressive responses as well as embarrassing and harmful displays
  • Health – Increased risk of hepatitis, cirrhosis, heart-rate changes, reflux esophagitis, decreased white blood cell counts and liver, kidney and/or heart damage

Likewise, alcoholism is commonly associated with mental health disorders. Per a 1990 edition of The Journal of the American Medical Association, 37 percent of alcoholics have one or more co-occurring mental health disorders, and approximately 10% of heavy drinkers have severe cognitive impairments. The previously referenced NIAAA study found that about 25% of functional alcoholics experience a major depressive illness at some point in life. Many of these people also have issues with anxiety, which might stem from societal and occupational pressure. Studies also find that male alcoholics have higher rates of bipolar disorder, attention-deficit hyperactivity disorder, schizophrenia and antisocial personality disorders, while female alcoholics have higher rates of depression, anxiety, panic attacks, posttraumatic stress, borderline personality and eating disorders. These issues are common in all alcoholics, functional or not.

Signs of a Functional Alcoholic

Functional alcoholics might think they hide their substance abuse, but the following signs reveal a potential problem:

  • Absentee issues at school/work following heavy drinking nights
  • Increased occurrence of physical and/or verbal altercations
  • Multiple instances of locking keys in the car or forgetting where it is parked
  • Strained relationships with friends, family and co-workers
  • Regularly drinking at home in the morning when all alone
  • Elevated tolerance levels that require excessive alcohol to get drunk
  • Issues remembering what events occurred during times of heavy drinking
  • Defensive responses when confronted by heavy drinking or behavior

The idea of a functional alcoholic might be a myth, but the benefits of rehab are not. The 2012 National Survey on Substance Abuse Treatment Services reports that nearly two-thirds of rehab admissions involve alcoholism, and this form of treatment remains the most effective way to treat addiction and co-occurring mental health disorders.

Alcohol Addiction Help

If you or a loved one struggles with alcohol abuse, then call our admissions coordinators for free help. Our staff can answer questions, recommend treatment and even check health insurance plans for rehab benefits. Our 24 hour helpline is toll-free, so please call now for instant help.

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