Q: How do you define a high-functioning alcoholic? What are the signs people should look for in themselves and in loved ones?

A: A high-functioning alcoholic (HFA) is an alcoholic who is able to maintain his or her outside life, such as a job, home, family and friendships, all while drinking alcoholically. HFAs have the same disease as the stereotypical "skid row" alcoholic, but it manifests or progresses differently. Many HFAs are not viewed by society as being alcoholic, because they have succeeded and overachieved throughout their lifetimes. These achievements often lead to an increase in personal denial as well as denial from colleagues and loved ones. HFAs are less apt to feel that they need treatment for their alcoholism and often slide through the cracks of the healthcare system, both medically and psychologically, because they are often not diagnosed.

HFAs can exhibit different drinking patterns and warning signs at various phases of their drinking. Common warning signs include, but are not limited to:

• Experiencing a craving for more alcohol after having one drink, leading to a loss of control over alcohol intake
• Obsessing about alcohol and the next time they can drink
• Not being able to imagine their lives without alcohol
• Feeling shame and remorse from drunken behavior
• Having failed attempts to control drinking
• Surrounding themselves with others who drink heavily
• Compulsively finishing alcoholic drinks—even someone else's
• Being skilled at living a compartmentalized life in terms of separating their drinking lives from their professional/family lives
• Making excuses for their drinking or using alcohol as a reward for their hard work
• Thinking that drinking expensive alcohol or wine implies they are not alcoholic
• Hiding alcohol consumption by sneaking alcohol before a social event or drinking alone
• Drinking despite adverse consequences (either emotional or physical)
• Experiencing blackouts or memory lapses