Alcoholics: Five Distinct Subtypes

Alcoholism is a complex disorder and alcoholics are subject to a number of unkind and incorrect stereotypes. In truth, there is no single type of problem drinker, but a study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has identified five distinct, identifiable subtypes.

The study, which involved nearly 1,500 individuals, considered factors such as family history, age when problem drinking began, and the presence of mental health disorders or other substance abuse issues. Researchers hope that the information will help alcoholics and their families understand the disorder, and that clinicians will create more effective, highly individualized treatment programs.

This is what they found:

Young adult – Members of the largest subtype display relatively low rates of mental disorders and typically have no problem with abuse of other substances, although a small percentage uses cigarettes or marijuana. Although they don’t drink as frequently as other subtypes, they tend to engage in binge drinking. Most have no family history of alcoholism and most aren’t likely to struggle with serious legal problems or psychiatric disorders. Less than nine percent have ever sought any form of treatment, and those that do generally seek help from 12-Step groups rather than rehabs or clinics.

Young antisocial – Members of this group, which tend to be in their mid-twenties, developed alcohol problems at a relatively early age. At least half come from families with a history of alcoholism, and approximately half fit criterion for antisocial personality disorder. Rates of major depression, bipolar disorder, social phobia and obsessive-compulsive disorder (OCD) are also common among this subtype. About three-quarters smoke cigarettes and marijuana, and many also struggle with addictions to cocaine or opiates. Problems with irresponsibility, impulsiveness or criminal behavior, including violence, aren’t uncommon. At least one-third seek some form of drug and alcohol treatment.

Functional – Most functional alcoholics are middle aged. Many are educated, and most have stable families, dependable jobs, and make more money than any other subtype. About half of smokes cigarettes and about a third have a family history of addiction. About one-quarter has struggled with serious depression at some point during their lives; otherwise, problems with severe mental illnesses aren’t typical. On average, they drink about every other day, consuming five to 10 drinks per occasion. Less than 20 percent seek help for alcohol abuse or addiction – usually private counselors or 12-Step groups.

Intermediate familial – Like the functional subtype, members of the intermediate familial group are also middle-aged, although they tend to have higher rates of unemployment. About half come from families with a multigenerational history of alcoholism. Nearly half have had severe depression at some point during their lives, and members of this subgroup have higher rates of other mental health disorders such as bipolar disorder, OCD, anxiety or antisocial personality disorder. About 20 percent have had problems with abuse of cocaine and marijuana. About one-quarter have sought treatment, usually in the form of self-help groups, detox, or private treatment providers.

Chronic severe – This is the smallest but most severely addicted subtype, comprising less than 10 percent of alcoholics in the United States. Nearly 80 percent grew up with addicted families and most had issues with substance abuse and addiction at an early age. They tend to have a very high rate of serious psychiatric disorders, including severe anxiety, bipolar disorder and severe depression, as well as high rates of abuse of other substances such as cigarettes, marijuana, opiates or cocaine. They drink frequently and often engage in binge drinking. This group is most likely to seek help from self-help groups and detox or drug and alcohol treatment or rehab.

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