Noah Vinter
It can be difficult to distinguish between controlling behaviour and concern for a loved one's alcohol consumption. Controlling people often try to regulate situations or people to an unhealthy degree, and this behaviour can stem from fear, anxiety, or past trauma. They may attempt to control others through manipulation, coercion, threats, or intimidation. On the other hand, a person with an alcohol use disorder (AUD) may exhibit specific signs such as drinking whatever alcohol is available, always having enough money for drinks, and displaying personality changes while under the influence. They may also experience negative consequences due to their drinking habits, such as DUIs or job loss, and struggle to quit despite their attempts to do so. Recognizing the signs of controlling behaviour and alcohol use disorder can help address these issues early on and establish healthier relationships.
| Characteristics | Values |
|---|---|
| Alcohol use disorder | Craving the next drink, experiencing withdrawal symptoms, and drinking despite adverse social, occupational, or health consequences |
| High-functioning alcoholics | Drinking alone, drinking in the morning, using alcohol for confidence, maintaining employment, handling day-to-day responsibilities, and thriving in social or professional settings |
| Alcoholism as a progressive disease | The condition will worsen over time, and the alcoholic will end up in recovery, jail, or death |
| Treatment | Medication, behavioural therapy, mutual-support groups, and alcohol counselling |
| Genetic and mental health factors | Family history of alcohol use disorder, depression, PTSD, and ADHD increase the risk of developing alcohol use disorder |
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What You'll Learn
High-functioning alcoholics: maintaining appearances
The term "high-functioning alcoholic" is not a formal clinical diagnosis, but rather a colloquial term used to describe someone who meets the criteria for an alcohol use disorder (AUD) and yet still manages to keep up appearances. They may be able to maintain employment, handle day-to-day responsibilities, and even thrive in certain social or professional settings. However, their drinking is out of control, and they are at risk of severe alcohol-related consequences.
High-functioning alcoholics often deny or minimize their drinking problem, believing that as long as they have a job, pay their bills, and have friends, they cannot be alcoholics. They may make excuses, such as only drinking expensive wine or claiming that drinking hasn't caused any setbacks in their lives. However, in reality, heavy drinking will eventually catch up with them. It can lead to liver disease, pancreatitis, certain cancers, brain damage, serious memory loss, and high blood pressure. It also increases the likelihood of death in a car accident or from suicide or murder.
Warning signs of high-functioning alcoholism include drinking alone, drinking in the morning, and using alcohol to boost confidence. They may also experience withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, and seizures. High-functioning alcoholics may put themselves or others in danger by drinking and driving, engaging in risky sexual behaviour, or experiencing blackouts.
High-functioning alcoholics often delay seeking help because they haven't hit a dramatic "rock bottom," which can lead to serious medical, financial, or interpersonal repercussions and complicate recovery efforts. Their loved ones may fall into a trap of codependency, protecting the alcoholic from the consequences of their disease and sacrificing their own needs to maintain a facade of normalcy. An intervention may be necessary to encourage a high-functioning alcoholic to seek treatment.
If you or someone you know may be a high-functioning alcoholic, it is important to seek help from a therapist, psychiatrist, or addiction specialist. Organizations such as the American Society of Addiction Medicine can provide guidance and support.
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Alcohol use disorder: a progressive disease
Alcohol use disorder (AUD) is a common medical condition that can be mild, moderate, or severe. It is characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can take over one's life, leading to damaged relationships and prioritising drinking over everything else. It also causes physical issues like craving alcohol and withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, dysphoria, malaise, feeling low, or seizures.
The risk of developing AUD depends on how much, how often, and how quickly one consumes alcohol. Genetics and family history also play a role, with people who have a family history of AUD or certain mental health conditions being at an increased risk of developing the disorder.
AUD is a progressive disease, and those affected may start with mild symptoms and progress to more severe ones over time. For example, they may begin to develop a high tolerance for alcohol and experience withdrawal symptoms if they do not drink. They may also find themselves in dangerous situations while drinking, such as driving or operating machinery, and continue to drink despite the adverse consequences.
AUD is a treatable disease, and with the proper treatment, most people are able to reduce their alcohol consumption or stop drinking entirely. Treatment options include medication and behavioural therapy. Three medications approved by the U.S. Food and Drug Administration to help reduce drinking and prevent relapse are naltrexone, acamprosate, and disulfiram. Behavioural treatments, such as alcohol counselling or talk therapy, can help individuals develop skills to cope with triggers and prevent relapse. Mutual-support groups can also provide valuable peer support for those in recovery.
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Treatment options: medication and therapy
Treatment options for alcohol use disorder (AUD) include medication and behavioural therapy. AUD is a common medical condition where people are unable to stop drinking, even when it negatively affects their health, safety, and personal relationships.
Medication
Three medications are currently approved by the U.S. Food and Drug Administration to help people stop or reduce their drinking and prevent a return to drinking: naltrexone (oral and long-acting injectable), acamprosate, and disulfiram. These medications are non-addictive and can be used alone or in combination with behavioural treatments or mutual-support groups. Doctors may also prescribe medicines to address alcohol withdrawal symptoms, which can be life-threatening and typically include trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, dysphoria, malaise, feeling low, or seizures.
Therapy
Behavioural treatments, also known as alcohol counselling or talk therapy, are provided by licensed therapists and are aimed at changing drinking behaviour. Examples include brief interventions, reinforcement approaches, treatments that build motivation, and mindfulness-based therapies. Cognitive-behavioural therapy (CBT) is a form of therapy that focuses on identifying the feelings and situations that contribute to heavy drinking and managing stress that can lead to a return to drinking. The goal is to change the thought processes that lead to alcohol misuse and to develop the skills necessary to cope with everyday situations that might trigger alcohol misuse. Motivational enhancement therapy is another form of talk therapy that uses internal strengths to encourage and motivate change.
Support Groups
Mutual-support groups provide peer support for stopping or reducing drinking and are typically available in most communities at low or no cost.
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Signs of alcoholism: cravings and withdrawal
Alcohol use disorder (AUD), or alcoholism, is a common medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. People with AUD may experience cravings for alcohol and withdrawal symptoms when they try to reduce their alcohol intake.
Cravings for alcohol are a key symptom of AUD. People with AUD may find themselves constantly thinking about their next drink and planning their lives around it. They may also drink more than they intended or for longer than they intended. This can lead to spending a lot of time obtaining alcohol, drinking it, and recovering from hangovers.
Withdrawal symptoms can occur when a person with AUD stops drinking or significantly reduces their alcohol intake. These symptoms can range from mild to severe and can be life-threatening. Withdrawal symptoms typically begin within six to 24 hours of stopping or reducing heavy, long-term alcohol use. Mild to moderate symptoms include anxiety, nervousness, irritability, excessive sweating, upset stomach, heart palpitations, increased blood pressure, increased heart rate, and tremors (shakiness) of the hands or other body parts. More severe symptoms include hallucinations, seizures, and delirium tremens (DT), which can be life-threatening and require immediate medical care.
The American Medical Association recommends a daily alcohol limit of two drinks for men and one drink for women. Heavy drinking is defined as five or more drinks per day or 15 or more drinks per week for men and four or more drinks per day or eight or more drinks per week for women. People with AUD may develop a high tolerance for alcohol, requiring them to drink more to achieve the desired effect. They may also experience withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, feeling uneasy or unhappy, a general sense of being unwell, feeling low, or sensing things that are not there.
If you or someone you know is experiencing cravings for alcohol or withdrawal symptoms, it may be a sign of AUD. It is important to seek professional help early. Treatment for AUD may include behavioural therapy, mutual-support groups, and medications such as naltrexone, acamprosate, and disulfiram.
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Impact on loved ones: deceit and denial
Alcohol use disorder (AUD), or alcoholism, is a common medical condition that can have a significant impact on the lives of not only the affected individual but also their loved ones. AUD is characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It is considered a brain disorder that can be mild, moderate, or severe.
Living with someone who has active alcohol addiction can affect all areas of life, from work and finances to physical well-being and relationships. Alcoholism thrives in secrecy and shame, and denial is a powerful dynamic for both the person with the disorder and their loved ones. Denial can manifest as defiance, blame, or deceit. For example, a person with AUD might claim they can quit drinking whenever they want or that they only had a couple of drinks. Loved ones often go into survival mode, trying to make it through each crisis. By the time families reach out for help, the disease may have progressed to a crisis level, involving accidents, job loss, arrests, or medical emergencies.
The impact of AUD on loved ones can be profound, with family members often feeling hurt, traumatised, and overwhelmed by their loved one's addiction. They may struggle with what to do or where to turn for help. It is important for them to recognise that AUD is a substance use disorder, a chronic and progressive disease that involves alterations in brain chemistry and circuitry. While they cannot make their loved one sober, they can educate themselves about addiction, seek out recovery resources, and embrace their own care and support. Support groups such as Al-Anon and Alateen offer free, accessible recovery programs for family members and friends of individuals struggling with addiction. These groups promote the understanding that loved ones did not cause the alcoholism, cannot control their drinking, and cannot cure it. Unconditional love and encouragement can help, but the desire to change must come from within.
Treatment for AUD typically includes medication and behavioural therapy, and studies show that most individuals are able to reduce their alcohol consumption or stop drinking entirely with treatment. Medications such as naltrexone, acamprosate, and disulfiram are non-addictive options that can be used alone or in combination with behavioural treatments. Behavioural therapies, such as alcohol counselling or talk therapy, aim to change drinking behaviour and develop skills to avoid triggers. Mutual-support groups also provide peer support and are available in most communities at low or no cost.
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Frequently asked questions
You might be exhibiting controlling behaviours if you:
- Feel anxious or angry when things don't go according to plan
- Try to isolate your partner from their friends and family
- Want to handle all the money in a relationship
- Insist on doing things your way
- Are critical of others
- Are a perfectionist with impossibly high standards
Your partner might be struggling with alcohol use disorder if you notice the following signs:
- Their social activities always revolve around alcohol
- They drink whatever alcohol is available, regardless of type or brand
- They always have just enough money for drinks
- They show no signs of intoxication after consuming large amounts of alcohol
- They undergo significant personality changes while drinking
- They are unable to quit drinking
If you notice signs of controlling behaviour or alcohol use disorder in yourself, it is important to seek professional help to address these issues. If you are concerned about your partner's drinking habits or controlling behaviours, have an open and non-judgemental conversation with them, expressing your concerns and offering your support. Encourage them to seek professional help and provide resources if possible. Remember, you are not responsible for their actions, but you can offer support and set boundaries to protect yourself.
