Taylor Swift sings about being ‘a functioning alcoholic.’ What does it mean?

Taylor Swift’s song “Fortnight” is getting a lot of attention for lyrics that include the line “I was a functioning alcoholic.”

Swift, who co-wrote the track, hasn’t said whether she’s singing about herself in the first single from her new album, “The Tortured Poets Department.” But she’s talked about giving up alcohol in recent months.

The singer once toured “like a frat guy,” but stopped drinking as she got in shape for her blockbuster Eras Tour to be able to keep up with its physical demands, she told Time in December 2023. Each concert on the tour, which resumes in May, lasts more than three hours and features a 44-song set list with demanding choreography.

“Doing that show with a hangover,” Swift said. “I don’t want to know that world.”

What is a functioning alcoholic?

There is no such medical term, and the word “alcoholic” is no longer used in medicine — the correct term is somebody who suffers from alcohol use disorder or alcohol addiction, says Dr. Lewis Nelson, a distinguished fellow of the American Society of Addiction Medicine.

Informally speaking, a “functioning alcoholic” is a person who drinks heavily, perhaps even unsafely, but can function in a day-to-day existence, he notes.

“They can hold a job, they can have friends, they can have a family. A lot of that, of course, is a misperception of reality. Because in reality, there is probably no such thing as a functioning alcoholic,” Nelson, professor and chair of the department of emergency medicine at Rutgers New Jersey Medical School, tells TODAY.com.

“It’s a pathway downward. … You can look normal to the outside world. You convince yourself that you’re ‘normal’ as you are compulsively using. Eventually, it will catch up with you.”

People who drink a lot can learn how to “hold” their alcohol a bit better, developing a tolerance to it and hiding their consumption well, but at some level, even that is going to be surpassed, Nelson says. As they spiral downward, they might suffer an injury, show up at work intoxicated or have a fight with a family member that will be unrecoverable.

In other cases, a person might think they're still functioning well at their job or maintaining good social ties, when, in fact, others are recognizing there's a problem.

About 20% of people with alcohol dependence were considered “functional,” a 2007 study done by National Institute on Alcohol Abuse and Alcoholism found. They were typically middle-aged, well-educated, and had stable jobs and families.

But “functional alcoholic” is a misnomer because it assumes someone who is living with alcohol use disorder is functioning fine while drinking excessively, the National Institute on Alcohol Abuse and Alcoholism now says.

“They may be functioning in one domain but not in other domains,” the agency tells TODAY.com in a statement. “Maybe they are working and no one notices any obvious problems, but their family or loved one relationships are failing.”

“In our world, you either have alcohol use disorder or you don’t. Your functionality is something that is relative,” Nelson adds.

Excessive alcohol use comes with serious health risks, especially for women.

What are the symptoms of alcoholism?

Addiction means compulsive use despite harm, Nelson says.

Almost 30 million Americans have alcohol use disorder, according to the most recent National Survey on Drug Use and Health.

It encompasses conditions referred to as alcohol abuse, alcohol dependence, alcohol addiction and alcoholism, the National Institute on Alcohol Abuse and Alcoholism notes.

The disorder can be mild, moderate or severe, and involves craving for alcohol, loss of control when it comes to drinking and feeling anxious when not imbibing.

To gauge symptoms, a doctor might ask questions such as:

• Have you wanted a drink so badly you couldn’t think of anything else?

• Do you spend a lot of time drinking, being sick from it or getting over the aftereffects?

• Do you continue to drink even though it’s causing trouble with your family or friends?

• Have you found that when the effects of alcohol wear off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart or feeling uneasy?

Nelson also likes to use the CAGE questionnaire, which asks if you've ever:

• Felt the need to cut down your drinking?

• Felt annoyed by criticism of your drinking?

• Had guilty feelings about drinking?

• Taken a morning eye opener? This refers to using alcohol first thing at the start of the day. “Do you need a drink when you wake up to ‘calm your nerves,’ to get your day started?” Nelson explains.

He recommends asking other questions, including: Do you use meals as an excuse to have a drink? Do you feel like you must have a drink at the end of the day to calm your nerves? Are your relationships suffering?

You don't have to drink alcohol every day to be classified as having a problem — binge drinking a few times a week can interfere with your life just as much as daily drinking, Nelson says.

“It takes a lot of introspection in order to be able to recognize this about yourself,” he notes. “Many people start out as ‘functional’ when they first start drinking and they convince themselves that they’re able to continue to do this.”

Help for alcohol addiction:

A primary care physician can be a good start — they can begin treatment or refer you to an addiction specialist. Medication and behavioral therapies can help.

The National Institute on Alcohol Abuse and Alcoholism offers an alcohol treatment navigator and a "Rethinking Drinking" guide.

“It is a devastatingly bad disease because not only does it affect you, it affects all of the people around you,” Nelson says.

This article was originally published on TODAY.com