Rebecca now realizes that this is no longer a joke. While she used to kid around calling herself a “functioning alcoholic,” that all changed when, after many attempts at cutting back, stopping drinking for a period of time, or setting limits, she suddenly lost her job of 10 years. She made an error that cost her company thousands of dollars and they fired her.

This was not her first mistake at work. Although the mistake was not attributed to alcohol use, it was serous enough to result in termination. Deep down in her heart, she questioned whether her nightly alcohol use had contributed but she then remembered that she is functioning just fine in all other areas of her life so she discounted these thoughts.

What is Alcohol Withdrawal Syndrome

For many like Rebecca, alcohol consumption can start with a limit of one drink a day but quickly escalate to seven drinks per week. While alcohol consumption is generally lookout at to be the "norm" in our society, we often disregard the potential risks of alcohol consumption at specific levels. For example, consuming more than one drink daily can lead to liver disease, cardiovascular disease, and many other injuries - including Alcohol Withdrawal Syndrome (AWS) when one stops drinking abruptly.

Alcohol Withdrawal Syndrome or "AWS" is commonly defined as a set of symptoms that occur when someone who is physically dependent upon alcohol suddenly stops drinking or drastically reduces their intake to prevent bodily injury. What happens is that the body suddenly goes through a state of shock and for a heavy, long-term drinker the brain will tend to adjust to its own chemistry to compensate for the effect of alcohol that is missing. Not only does this produce naturally stimulating chemicals but the adrenaline is typically felt in larger quantities than normal.

Specific signs and symptoms of the states of AWS may include:

  • Headaches
  • Tremors
  • Anxiety
  • Fatigue
  • Insomnia
  • Gastrointestinal Disturbances
  • Heart Palpitations
  • Hyperthermia
  • Hallucinations
  • Seizures
  • Mood Changes

  • Signs of Alcohol Use Disorder

    For many like Rebecca, she is a 40-something wife, mother, and sister seemingly at the top of her game. She has a graduate degree. She and her husband have been married for 16 years. They own a modest home in a nice suburban community. Her kids, ages 9 and 14, are busy and seem to be thriving. They are doing well in school and are active in after school activities.

    Rebecca had been stable and secure in her job and had been doing it so long that she joked she could do it in her sleep. Her friends, family, and colleagues marvel at her ability to juggle fulltime work with managing a busy household. She is the family’s major breadwinner. She tries to attend her kids’ soccer and lacrosse games and participates in several carpools, although she prefers to avoid late-night pickups.

    Once Rebecca gets home, she begins dinner prep for the family. She pours herself a glass of wine in order to unwind after a long day, because who doesn’t? Work is stressful, juggling is stressful. She tells herself “I deserve it.” When the family sits down for dinner, she pours herself a second glass and her husband has one as well. She keeps topping her glass off until the entire bottle is empty. She and her husband clean up from dinner and it’s time for the evening rituals of homework, bathing and teeth brushing for the children.

    What Rebecca may not be noticing just yet, is that although one glass of wine may seem quite typical, her bottle being empty is only leading to more serious problems ahead. Alcohol Use Disorder or "AUD" is a medical condition that doctors diagnose when a patient's drinking causes distress or harm. This term ranges from mild to severe symptoms and is diagnosed when a patient confirms yes to two or more questions in the below criteria:

    In the past year, have you:

  • Had more times when you ended up drinking more, or longer than you intended?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn't?
  • Spent a lot of time drinking? Or being sick or getting over the alter effects?
  • Experienced a craving - a strong need, or urge, to drink?
  • Found that drinking - or being sick from drinking - often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex?)
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating?
  • For those that answered yes to two or more of the questions above, a person's risk for developing AUD may be higher. Other factors that do increase the risk of AUD can include drinking at an early age, genetics and family history of alcoholism, as well as mental health conditions or history of trauma.


    In Rebecca's case, her experience quickly turns for the worst and she sits down at her computer to check her emails, pay bills and do some online shopping. Without even thinking, Laura opens another bottle of wine for herself. By the end of the evening she is watching TV and without much thought, opens another bottle of wine in order to drink a glass from it. Again, before she knows it a second bottle is empty. But she justifies, rationalizing that her husband did have one glass.

    The following night she is scheduled to have dinner with a couple of girlfriends – other moms in the neighborhood. She has a quick glass of wine as she puts on her makeup, “pre-gaming” as they call it. At dinner, the three women each have a cocktail and share a bottle of wine. Rebecca returns home and sits in front of the TV. Without even thinking, she pours herself a glass of wine and before the glass is empty, tops it off one more time.

    She doesn’t want to think about it, but she has had about 4-5 glasses of wine and a cocktail throughout the evening. There is a nagging feeling in her gut and her mind: “Is this a problem?” She quickly dismisses these thoughts and remembers that she is functioning just fine. No need to do anything differently.

    Rebecca has a fitful night’s sleep and wakes up at 6am feeling groggy, with a headache and very dry mouth. She feels anxious. She looks in the mirror and notices that her skin is puffy under her eyes. She does the best she can with her makeup and figures her glasses will take care of the rest. She makes the kids lunches and gets them on the school bus before making her way to work.

    This scenario plays out in one form or another almost every day of the week. On the weekends, her husband lets her sleep in while he takes care of the kids. After a week of early mornings and poor sleep, she is exhausted.

    It wasn’t always like this for Rebecca. She hardly drank as a teenager or in college. She began having a glass of wine with her husband before the kids were born. During her maternity leaves, she would start drinking wine late in the afternoon before her husband came home as a way to unwind. Over the years, this progressed to where we find her now, drinking 2 bottles of wine a night and “barely feeling it.”

    She has considered herself to be “functioning alcoholic.” That all changed when she got fired. After she was laid off, she became depressed and started taking antidepressants and antianxiety meds for her now increased levels of anxiety. Her wine consumption remained at 1-2 bottles per night. She began therapy but when she discussed drinking with her therapist, she minimized the amount that she really drank.

    This is an all too common scenario. Does it sound like anyone that you know? Or do parts of the story apply? Alcohol Use Disorder (AUD) is now seen as a spectrum of usage patterns and amounts.


    Types of Treatment for an Alcohol Use Disorder

    AUD can manifest in different forms: nightly drinking or binge drinking. But AUD in any form is progressive and gets worse over time. Abnormal pathways in the brain are established and there is little to no input through the prefrontal portion of the brain which helps regulate decision making. or this reason, more and more negative consequences occur including DUI’s, job loss, failed relationships and even incarceration.

    Because every patient is different when it comes to to a treatment approach, while one therapy can work for a specific individual it may not work for the other. Typical treatments can include medication, behavioral counseling, mutual-support groups, and more. At the Coleman Institute, we begin our treatments with a thorough replenishment of vitamins and minerals that your brain needs, paired with medication to keep you calm and careful monitoring prior to your leave. Within two-three days you can return to our office regularly and gain guidance with a comprehensive recovery program that could include Naltrexone Therapy

    If you or someone you know and love uses the term “functioning alcoholic” to describe themselves, I hope that this article will resonate with you and you will be able to determine if they need to make a change and guide them on where to do so. Change can happen at any time. One does not have to hit "rock bottom" as believed in the past.

    Withdrawal from alcohol can be dangerous. Let us help you develop a personalized plan that supports a sustained recovery and long-lasting care.

    Deborah Reich, MD