Taylor Swift’s fans have suspected the singer’s references to drinking habits in the first single from her new album, The Tortured Poets Department, are personal. The lyrics to the song “Fortnight” include the line, “I was a functioning alcoholic / ’til nobody noticed my new aesthetic.”
An estimated 29.5 million people over age 12 living in the United States have alcohol use disorder (AUD), according to data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
Alcohol use disorder affects people in different ways, and the term “alcoholic” can be both stigmatizing and lead to people not realizing they may have AUD, says Richard Piper, PhD, CEO of Alcohol Change UK, a nonprofit organization based in England and Wales.
People typically have an idea in their head of what an “alcoholic” looks like, he says.
“This stereotype can be a real problem. We might find ourselves drinking very heavily, in ways that are damaging our mental and physical health, but because we don’t match up to our mental image of an ‘alcoholic,’ we don’t see ourselves, and aren’t seen by others, as having a problem,” Dr. Piper says. “That’s a big barrier to getting help.”
Is ‘Functional’ Alcohol Use Disorder Possible?
A “functional alcoholic” is a term used for someone that meets criteria for AUD— including having tried to stop drinking but not being able to; having symptoms of withdrawal; or had times when they drank more or for longer than they intended to — but can maintain their job and family responsibilities, says Brad Lander, PhD, a clinical psychologist and addiction medicine specialist in the department of psychiatry and behavioral health at The Ohio State University Wexner Medical Center in Columbus.
“Often, even people close to them are unaware they have a problem,” Dr. Lander says, adding that this doesn’t last forever. “In the earlier stages of alcohol use disorder, it is easy for people to hide how much they drink, and for others to dismiss signs of problem drinking. But alcohol use disorder is progressive, and the symptoms will become increasingly obvious.”
Karl Sieg, MD, a psychiatrist board-certified in addiction medicine and the lead medical director with Florida-based Evernorth Behavioral Health, agrees that symptoms of AUD eventually become visible.
“Usually there is an inflection point where the person’s dependency progresses to a state where they can no longer hide the symptoms of alcohol use disorder,” he says.
Warning Signs of Not-So-Hidden Alcohol Use Disorder
According to Lander, one of the first signs a person may have AUD is if they are hiding their drinking, or how much they are drinking. They may also feel agitated or uncomfortable until they can get a drink, or drink at inappropriate times, such as in the morning.
Once the disease progresses, people with AUD may forget to pay their bills or forget to pick the kids up from their activities, says Dr. Sieg. They might be tardy more often, irritable, paranoid, or have difficulty remembering conversations.
People may lose friends over something they did while drinking, or get into legal trouble, such as driving under the influence (DUI).
“As a rule of thumb, one incident is a learning experience, multiple incidents indicate a problem,” Lander says.
The diagnostic criteria for AUD include symptoms of mild, moderate, or severe AUD, so there is a wide spectrum of what alcohol use disorder looks like.
“Instead of asking ourselves, ‘Am I an alcoholic?’ it’s better to ask, ‘Am I happy with my drinking?’” Piper says. “There’s no sudden moment when someone goes from being fine to having a problem, and you can get help at any point.”
How to Get Help for Problematic Drinking
If you find yourself drinking alcohol earlier in the day than you used to, hiding your drinking from others, or you are choosing drinking over tackling your responsibilities, it may be time to reach out for help, Piper says.
Just as AUD looks different in different people, so does the treatment plan each person needs.
The first step is to get an assessment from a substance use disorder specialist, says Lander.
“They can determine if there is a problem and what type of treatment may be needed. Treatment recommendations can run the gamut from inpatient treatment to community support activity,” he says, noting that even so-called “functional alcoholics” may need a period of detox in the hospital.
If you suspect someone in your life may have unhealthy drinking habits, approaching them about it can be difficult, says Stacey Rivenburg, PsyD, a psychologist advisor for the behavioral health managed care organization of AmeriHealth Caritas in Pennsylvania.
Approaching that person with compassion is key, she says. Using “I language” that centers around your worries and how someone’s behavior is impacting you can make the conversation feel less confrontational.
Lander recommends starting by encouraging a person to get an evaluation, rather than telling them to go to treatment, which a person is more likely to resist.
“It’s very difficult to approach a person about suspected alcohol use disorder because they may deny it, either out of defensiveness or lack of recognition they have a problem,” says Sieg. “The most important thing is to be nonjudgmental and use facts, or examples of symptoms they’ve exhibited at home or on the job, to showcase your concern.”
