According to the Office of Disease Prevention and Health’s Dietary Guidelines for 2015-2020, moderate alcohol consumption is considered up to 1 drink per day for women and up to 2 drinks per day for men.1 While even moderate drinking has some risks, the risks increase significantly when a person’s alcohol intake moves beyond moderate consumption—for example when binge, heavy, or excessive drinking becomes the norm.1,2 One of these risks is the potential for developing an alcohol use disorder, or AUD.2
Risky drinking and alcohol abuse are not synonymous with alcohol addiction; however, they may lead to an AUD. 2 Here, we’ll define alcohol abuse, provide red flags for problem drinking, list the criteria for an alcohol use disorder, and discuss the concept of the high-functioning alcoholic. Armed with this information, you may be able to identify a problem in yourself or a loved one and seek help for alcohol addiction.
How Much Alcohol Is Too Much?
In the U.S., drinking is often a part of everyday life. From cocktails after work to beers at a baseball game, alcohol is a part of so many social activities. And because drinking is so normalized, it can be hard to differentiate where acceptable, social drinking crosses over into alcohol abuse.
Knowing what constitutes excessive alcohol consumption can help you determine if your or someone else’s drinking is moving into dangerous territory.
What Is Excessive Drinking?
Excessive drinking is an umbrella term that encompasses the following:3
- Heavy drinking.
- Binge drinking.
- Any alcohol use by a person under 21 years old.
- Any alcohol use by a pregnant woman.
The Centers for Disease Control and Prevention (CDC) defines heavy drinking as:3
- Women: 8 or more drinks per week.
- Men: 15 or more drinks per week.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) gives a slightly different definition that breaks the numbers of drinks down by day instead of by week:2
- Men: More than 4 drinks on a given day.
- Women: More than 3 drinks on a given day.
Binge drinking—sometimes called “heavy episode drinking,” or HED—refers to drinking that brings a person’s blood alcohol content (BAC) to a level of 0.08 or higher.2,4 The CDC and NIAAA provide the following estimates for what it will take for both men and women to reach this BAC:2,3
- Men: 5 or more drinks in a 2-hour period.
- Women: 4 or more drinks in a 2-hour period.
According to the World Health Organization, binge drinking is “one of the most important indicators for acute consequences of alcohol use, such as injuries.”
The risks of excessive drinking are many and include short-term risks such as injury and alcohol poisoning to long-term risks such as cancer, heart disease, liver disease, and mental health problems.3
According to the CDC, the majority of people who drink to excess are not alcohol-dependent or have an alcohol use disorder; 3 however, regularly engaging in heavy or binge drinking is a risk factor for AUD.2
Warning Signs of Alcohol Abuse
Someone may engage in binge drinking from time to time or drink more heavily one day than other days, but this doesn’t mean they are abusing alcohol regularly or that their drinking has become problematic. Some signs of alcohol abuse that go beyond the number of drinks a person has on a given day or week include the following:5,6,7
- Ignoring personal hygiene or appearance.
- Suddenly changing friends/social groups.
- Performing poorly at school or work.
- Losing interest in favorite activities or hobbies.
- Sleeping more or less than usual.
- Eating more or less than usual.
- Having problems in interpersonal relationships.
- Losing friends over their drinking or hearing a lot of comments/concern from friends about their alcohol use.
- Experiencing legal problems due to alcohol use.
- Taking risks with alcohol, such as taking care of small children or driving while under the influence, drinking during pregnancy, or mixing alcohol with medications.
- Regularly using alcohol to feel differently, such as to relieve stress or anxiety, or to feel more comfortable in social situations.
- Feeling guilt about drinking.
- Attempting to hide alcohol or keep alcohol purchases secret.
- Needing alcohol in the morning to feel better or relieve a hangover.
- Having alcohol-induced blackouts or memory problems.
- Hurting others while intoxicated.
- Worrying about not having enough alcohol to get through a brief time period, e.g., the weekend.
- Sneaking alcohol at social events.
- Having trouble ending an episode of drinking.
The above signs may indicate that a person is on a dangerous path to developing a problem with alcoholism.
Recognizing the Signs of an Alcohol Use Disorder
Problem drinking can over time grow into an alcohol use disorder, diagnosed by doctors when drinking causes health problems, distress, or other harms in a person’s life.8
A person may be diagnosed with an AUD if they meet 2 or more of the following criteria in a 12-month period:9
- Consuming more alcohol than intended or drinking longer than intended.
- Trying to cut down on drinking more than once and not succeeding.
- Spending a lot of time getting alcohol, drinking, or feeling hungover.
- Craving alcohol or having a strong urge to drink.
- Engaging in risky activities (e.g., having unprotected sex, driving, or operating machinery) while intoxicated.
- Finding that drinking, or being sick after drinking, interferes with work, school, or family responsibilities.
- Cutting back on important activities or hobbies to drink.
- Continuing to drink even when it has caused problems in relationships with friends and family.
- Continuing to drink knowing that alcohol has caused or worsened a physical or mental health issue.
- Developing a tolerance for alcohol (needing to drink more to feel the effects).
- Experiencing withdrawal symptoms while not drinking and/or taking another substance such as a benzodiazepine to prevent or relieve withdrawal symptoms.
What Is a High-Functioning Alcoholic?
People with substance abuse problems are impacted by their problematic drinking patterns in many different ways. People who suffer from a severe substance abuse problem do not function well in their daily lives, while others may convince others and even themselves that they don’t have a problem. Those who continue to keep up appearances while drinking excessively may be informally referred to as a “high-functioning alcoholic.”10
A high-functioning alcoholic is a person who abuses alcohol frequently and yet is still able to keep some semblance of normality in their lives. They may continue to hold a job, take care of financial issues, or care for children. In some cases, such a person may be a position of power, and people around them may overlook the drinking because of it. The individual may present an image that is contradictory to the typical image of the disheveled alcoholic; they may be well put-together, refined, successful, and respected in their industry.10
The high-functioning alcoholic may be especially good at compartmentalizing, keeping their drinking separate from other areas of their life. They may be living a “double life” in a sense, drinking excessively in secret and presenting a completely different image in public. Their ability to compartmentalize so well may only serve to perpetuate their denial or the denial of those who love them.10
While a functioning alcoholic may be able to maintain the appearance of an orderly or managed life and may not hit any kind of obvious “rock bottom,” generally there are issues under the surface that become more apparent over time. Problems may emerge in the form of relationship conflict, health problems, financial woes, or legal troubles (such as DUIs). 10 One professor of a graduate-level substance-abuse class at Northeastern University, Dr. James Scorzelli, said of high vs. low-functioning alcoholism, “Whether or not you are high-functioning or low-functioning, it is all the same disease.” 10 The distress that it causes may not be immediately apparent, but it’s still there.
Even if a person appears to be holding it together and not hitting some kind of bottom, they may still need help for alcoholism.10 Getting help for a drinking problem does not mean waiting until the problem completely destroys your life. In fact, research has shown that early intervention is the best way to help someone with drug and alcohol use issues.11
Am I a High-Functioning Alcoholic?
High-functioning alcoholics may be very good at self-denial and denying to loved ones that anything is wrong, but the following signs may indicate that, in fact, a problem with alcohol abuse is lying below the surface. Someone who is still functioning at a relatively high level may be struggling with alcoholism if they:10
- Are unable or unwilling to moderate their drinking and compulsively finish drinks, even those belonging to others.
- Drink in secret or lie about how much they’re drinking.
- Organize their lifestyle in a way that reduces or eliminates the possibility of negative feedback about their alcohol use.
- Use labels for their drinking, calling it a “habit” or a “vice.”
- Deny their drinking is a problem because their lives are still manageable, they don’t fit the addict stereotype, or they’re successful.
- Compare themselves to other alcoholics whose lives look very different.
- Believe that drinking expensive alcohol or drinking in upscale environments means they don’t have a problem.
- Use alcohol as a reward for hard work.
When Is It Time to Get Help?
If you, or a loved one, are struggling with alcohol abuse issues, it’s important to get help as soon as possible. You don’t need to wait for an alcohol use disorder to fully develop. Oftentimes, treatment will be more effective when it is sought early, and this means getting help as soon as alcohol abuse becomes apparent.11
Treatment for alcohol use disorders may consist of one or more of the following:
- Medical detoxification. For alcohol-dependent individuals, medical detox is a priority. The alcohol withdrawal syndrome can be one of the most dangerous of all substance withdrawal syndromes. Undergoing withdrawal after long-term excessive alcohol abuse can cause life-threatening withdrawal symptoms such as delirium tremens (DTs).12
- Inpatient rehab. An inpatient treatment environment provides significant support and a sober environment in the first weeks and months of recovery.
- Outpatient treatment. There are several levels of outpatient care ranging from very intensive (partial hospitalization) to much less intensive (standard outpatient therapy). What you elect will differ based on how much support you need and how you and your doctor or treatment team feel you’re progressing in your recovery.
- Mutual help groups/12-Step organizations. Often incorporated into both inpatient and outpatient treatment, alcoholics in recovery will often attend 12-Step (AA) or other support groups (e.g., SMART Recovery) for years after completing treatment.
Alcohol abuse treatment will often involve more than one of the above. For example, someone may go from medical detox into an inpatient program and then through one or more levels of outpatient care. Recovery First offers many levels of care for comprehensive treatment, from safe medical detox to intensive outpatient programming. We also offer specialized treatment for veterans struggling with alcoholism and for licensed healthcare professionals whose careers may have been impacted by their alcohol use.
To learn more about our offerings and to get help for yourself or a loved one, call us at 954-526-5776 today. We’re here for you.
- Health.gov. (n.d.). Dietary Guidelines 2015 to 2020: Appendix 9. Alcohol.
- National Institute on Alcohol Abuse and Alcoholism. (n.d.). What are the Different Drinking Levels?
- Centers for Disease Control and Prevention. (2019). Alcohol Use and Your Health.
- World Health Organization. (n.d.). Heavy episodic drinking among drinkers.
- National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: What are signs of drug use in adolescents, and what role can parents play in getting treatment?
- Substance Abuse and Mental Health Services Administration. (n.d.). Alcohol Use Facts and Resources.
- American Academy of Family Physicians. (2004). Alcohol Abuse: How to Recognize Problem Drinking.
- National Institute on Alcohol Abuse and Alcoholism. (n.d.). What are symptoms of alcohol use disorder?
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
- Benton, S. (2009). Understanding the High-functioning Alcoholic: Professional Views and Personal Insights. Westport, CT: Greenwood Publishing Group.
- Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov. CHAPTER 4, EARLY INTERVENTION, TREATMENT, AND MANAGEMENT OF SUBSTANCE USE DISORDERS.
- Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.