A functioning alcoholic is someone with a dependence on alcohol who manages to maintain a high level of function. This is not an official medical term and is in use by laypeople to describe alcoholics who do not fit the stereotypes associated with alcoholism. Functional alcoholics, as they are also called, are dependent on alcohol but mask it with their professional and personal successes. Often, it is not until a crisis situation occurs that the alcoholic is diagnosed and receives treatment.
When someone is a functioning alcoholic, the person consumes a high volume of alcohol on a regular basis and can experience medical problems associated with alcohol dependence like liver damage, general malaise, and malnutrition. Obsessive thoughts about alcohol are common, and the alcoholic may count down the time until the next drink, refuse to attend events where drink is not served, and experience blackouts.
However, the functioning alcoholic may also hold down a job, often a high powered and stressful one. Functioning alcoholics can be active with their families, contribute to their communities, and appear, on the surface, to be healthy, well-balanced individuals. Their alcohol consumption may be noted, but not addressed, because people believe it is not an issue, since the person's life does not seem to be in a state of disruption as a result of alcohol dependence.
With no one to comment about alcohol consumption, a functioning alcoholic can remain in a state of denial and will generally not seek treatment for alcohol dependence or abuse, as the person doesn't think there is a problem. An event like a drunk driving citation, a mistake at work while drunk, or a similar crisis precipitates a reevaluation of the person's life and may reveal the alcohol problem. The crisis can lead to treatment, but not in all cases; excuses are often made for functioning alcoholics and the event may be attributed to a one-time lapse in judgment.
It is not uncommon for functioning alcoholics to be very bright, driven, and motivated individuals. They may be reluctant to seek treatment because they don't want to show weakness or they are afraid of the career consequences of going to a treatment facility. The people around them may not believe that they have an alcohol problem, and this can contribute to the denial associated with functioning alcoholism.
Doctors can screen for signs that someone is a functioning alcoholic by asking how much alcohol the person consumes, whether the person has obsessive thoughts about drinking, and checking for physical signs. However, this screening must be conducted with care, as the patient may lie or obscure details to maintain denial about the alcoholism.