A doctor has explained the four red flag signs that could mean you are a functioning alcoholic.
Many people picture an alcoholic as someone whose life is visibly falling apart, but according to experts, the number of “functioning alcoholics” is on the rise, and the warning signs are often more subtle than you might think.
The NHS defines alcohol misuse as drinking in a way that’s harmful or being dependent on alcohol. Both men and women are advised not to regularly drink more than 14 units a week to keep health risks low.
Dr Iqbal Mohiuddi - one of the consultant psychiatrists at 25 Harley Street Day Clinic - has said that a third to a half of the clients he treats for alcohol addiction don’t fit the typical image of an addict.
“They’re working in high-powered jobs, in the City or the media, and drinking heavily is accepted, almost expected,” he told Healthista. “They have carried on for years in this way, but suddenly they’re getting physical symptoms such as feeling sick in the mornings and needing a drink, and perhaps a partner has said they have had enough and it’s the drink or them.”
He explains that as more companies become aware of alcohol issues in the workplace, they may send employees for detox treatment to protect their health. Many of these individuals continue managing their daily responsibilities while hiding the extent of their drinking and denying the seriousness of their alcohol intake.
Travis Chenoweth, a social worker at Banner Behavioral Health Hospital in Arizona, adds that people with mild or moderate alcohol use disorder may pay their bills, maintain relationships, and hold down good jobs while continuing to drink.
“They may be quite skilled at hiding their alcohol use and not fit ‘alcoholic’ stereotypes,” he said, cited by Banner Health.
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To help identify functioning alcoholism, experts often use the four-point acronym CAGE:
- C – Cutting down: Have you ever thought you should probably drink less?
- A – Annoyance: Do you get annoyed when people nag you about your drinking?
- G – Guilt: Do you feel guilty about your drinking or what you do as a result?
- E – Eye-opener: Do you need a drink in the morning to relax or steady your nerves?
According to Dr Mohiuddi, answering yes to even a couple of these questions could indicate a problem with alcohol.
“During a binge, your body is literally saturated with alcohol, and even though you think you can tolerate it, your body isn’t breaking it down any quicker,” he explained. “A good mantra to keep in mind is that human beings can only tolerate one unit of alcohol in an hour, so try and stick to that.”
The NHS adds that someone may be misusing alcohol if they regularly drink more than 14 units a week, sometimes can’t remember what happened the night before, or fail to meet responsibilities because of drinking, such as missing work or appointments.
Heavy drinking can also look like having more than five drinks on any day or more than 14 in a week for men, and more than four drinks on any day or more than seven in a week for women, according to the National Institute on Alcohol Abuse and Alcoholism.
Marcia Giannotti, a social worker at Banner Behavioral Health Hospital, notes that “‘high-functioning alcoholism’ is an oxymoron,” explaining that alcohol is neurotoxic and inflammatory and can damage your body in many ways over time.
Even those who appear to function normally are at risk for health issues, including high blood pressure, certain cancers, liver problems, memory loss, and, eventually, alcohol-related death.
If you are concerned about your drinking, Dr Mohiuddi suggests using the Alcohol Change drinking quiz to understand if your habits might be impacting your health.
For those seeking help, treatment can include therapy, medication to reduce cravings, and inpatient programs. Support groups like Alcoholics Anonymous, Smart Recovery, or Celebrate Recovery can also provide structured support.
For people with alcohol use disorder, Chenoweth says, “it is not possible to drink moderately. The safest option is not to drink at all.”
If you would like to speak to somebody about alcohol dependency, help is out there.
In the UK, you can contact the Drinkline national alcohol helpline on 0300 123 1110, or visit Alcohol Change UK, Alcoholics Anonymous (helpline on 0800 9177 650), or Al-Anon Family Groups (helpline on 0800 0086 811).
In the US, you can visit National Institute on Alcohol Abuse and Alcoholism (helpline on 301–443–3860), NIAAA Alcohol Treatment Navigator®—How to Find Quality Alcohol Treatment, or contact the Substance Abuse and Mental Health Services Administration's (SAMHSA) National Helpline at 1-800-662-HELP (4357).