“Clinicians have long recognized diverse manifestations of alcoholism and researchers have tried to understand why some alcoholics improve with specific medications and psychotherapies while others do not. The classification system described in this study will have broad application in both clinical and research settings.”
~Ting-Kai Li, M.D., the Director of the National Institute on Alcohol Abuse and Alcoholism until 2008
Alcoholism is a very personalized disease, manifesting differently in every person. Because the contributing factors, the family/personal history, the environment, and the severity of the disease can vary from person to person, Alcohol Use Disorder (AUD) treatment must also be adaptable to the individual.
Over the years, addiction researchers have been able to more distinctly distinguish what characterizes a person who suffers from a substance use disorder, commonly referred to as an addict or alcoholic and this clarification has made it possible to categorize the different sub-types of substance abusers.
In the case of Alcohol Use Disorder (AUD), the ability to identify the type of alcoholic a person is makes it that much easier for rehab professionals to create a personalized treatment plan for each individual that attacks the disease both at the source and in a matter that targets the specific manifestation.
A Modern Analysis of the Alcoholic Types
Past efforts to categorize the individual subtypes of alcoholism primarily focused on those people who were either hospitalized or receiving some other professional treatment for their illness.
But recent reports from the NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions indicate that only about one-quarter of people with AUDs have ever had ANY treatment. This means that the largest percentage of alcoholics – and their individual sub-types – were not accurately represented in earlier studies.
The NESARC studies alcohol, drug, and mental disorders in the U.S. and is meant to be representative of the country as a whole. Around 1500 respondents from across America who met the standard for a clinical diagnosis for alcohol dependence participated – both individuals in rehab and those not yet seeking professional treatment.
Based upon several factors, researchers identified five distinct alcoholic sub-types. The factors included:
- Individuals’ family history of alcoholism
- Their age when habitual drinking began
- Their timeline of alcohol abuse/dependence
- Any co-occurring substance abuse or mental disorders
Alcoholic Sub-Type #1– Young Adult
This subtype makes up nearly a third of American alcoholics – 31.5%, making it the largest sub-type.
Collectively, they have a lower rate of comorbid disorders, fewer histories of alcoholism within their family, and are less likely to seek AUD treatment.
Alcoholic Sub-Type #2 – Young Antisocial
This sub-type accounts comprises roughly a fifth of all American alcoholics – 21%.
Typically, young antisocial alcoholics are in their mid-twenties and have a personal history that includes an early onset of alcohol problems. More than half have a history of alcoholism within the family, and approximately 50% have also been diagnosed with an Antisocial Personality Disorder (ADP). In addition, many suffer from major depression, anxiety, or bipolar disorder.
More than three-quarters smoke – both regular tobacco and marijuana – and many have an addiction to opiates or cocaine.
In contrast to “Young Adult” sub-types, over 33% of young antisocial alcoholics actually seek help for their AUD.
Alcoholic Sub-Type #3 – Functional
Functional alcoholics represent a smaller percentage of alcoholics – roughly 19%.
This sub-type is typically older than the others. They are usually middle-aged, well-educated, gainfully employed at stable jobs, and appear to have a “normal” family/home life.
Around a third of alcoholics in this sub-type have a family history of problem drinking that goes back multiple generations. Additionally, 25% have a personal history of major depression. Half smoke cigarettes.
Alcoholic Sub-Type #4 – Intermediate Familial
Intermediate familial alcoholics make up a fifth of American alcoholics – 19%.
This sub-type is typically made up of people who started drinking in their teens, but became alcoholics in their mid-30’s. 50% of the people within this sub-type have family histories with multi-generational alcoholism.
Approximately half meet the criteria for a clinical diagnosis of depression, while around one-fifth struggle with a bipolar disorder. Most intermediate familial alcoholics smoke cigarettes, and about 20% have abused cocaine or marijuana.
Only about one out of every four intermediate familial alcoholics have ever actively sought alcohol abuse treatment.
Alcoholic Sub-Type #5 – Chronic Severe
Accounting for only about 9% of American alcoholics, this is the smallest sub-type.
Chronic severe alcoholics demonstrate the role played by genetics and an early onset of drinking problems, and how other co-occurring mental/personality disorders and alcoholism can present simultaneously.
Most chronic severe alcoholics are middle-aged men with a personal history that includes an early onset of problem drinking. Four out of every five alcoholics within this sub-type come from families with multi-generational alcoholism.
Chronic severe alcoholics suffer from the highest rates of mental/psychiatric disorders, including Antisocial Personality Disorder (APD), depression, anxiety, and bipolar disorder. Among the alcoholic types, they also have the highest divorce rate.
A large percentage of chronic severe alcoholics smoke, and many also abuse marijuana, cocaine, and opiates.
This type of alcoholic is the most common sub-type found in alcohol rehab – approximately 67% seek professional help for their AUD.
Why Is It Important to Identify Alcoholic Sub-Types?
Because alcoholism has been medically-labeled as a disease, being able to determine the precise manifestation and severity of that disease as it presents in a person gives addiction professionals an invaluable tool that can create more individualized and effective treatment plans.
Even more, when a person fully grasps the concept that they have a disease – instead of a moral weakness – a proper classification can help an alcoholic in recovery gain a better understanding of how their disease is affected by everything else.
- Family history (genetics)
- Other abused substances (contributing environment/personal history)
- Any diagnosed mental problems (co-occurring disorders)
These classifications are also helpful because they show the alcoholic that he or she is not alone– there have been others with the same disease who were able to recover their sobriety.
Classification can also convince the alcoholic to accept help via a professional treatment program, when they see that AUD treatment is practiced like any other branch of medicine.
NorthPoint Recovery specializes in alcohol detoxification and residential rehab. The program offered is evidence-based and wellness-focused, and attacks the disease of addiction on multiple levels. This approach gives people in recovery their best chance at a successful return to sobriety.