Five Subtypes of Alcoholism

Researchers have identified 5 distinct subtypes of alcohol dependence, according to a new study by scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH).

“Our findings should help dispel the popular notion of the ‘typical alcoholic,’” notes first author Howard B. Moss, M.D., NIAAA Associate Director for Clinical and Translational Research. “We find that young adults comprise the largest group of alcoholics in this country, and nearly 20% of alcoholics are highly functional and well-educated with good incomes.”

The unique subtypes were based on respondents’ family history of alcoholism, age of onset of regular drinking and alcohol problems, symptom patterns of alcohol dependence and abuse and the presence of additional substance abuse and mental disorders.

Following are the 5 subtypes, as defined by the study:

Young Adult subtype: 31.5% of U.S. alcoholics. Young adult drinkers with relatively low rates of co-occurring substance abuse and other mental disorders, a low rate of family alcoholism and who rarely seek any kind of help for their drinking.

Young Antisocial subtype: 21% of U.S. alcoholics. Tend to be in their mid-twenties, had early onset of regular drinking and alcohol problems. More than half come from families with alcoholism, and about half have a psychiatric diagnosis of Antisocial Personality Disorder. Many have major depression, bipolar disorder and anxiety problems. More than 75% smoked cigarettes and marijuana, and many also had cocaine and opiate addictions. More than one-third of these alcoholics seek help for their drinking.

Functional subtype: 19.5% of U.S. alcoholics. Typically middle-aged, well-educated, with stable jobs and families. About one-third have a multi-generational family history of alcoholism, about one-quarter had major depressive illness sometime in their lives, and nearly 50% were smokers.

Intermediate Familial subtype: 19% of U.S. alcoholics. Middle-aged with about 50% from families with multi-generational alcoholism. Almost half have had clinical depression, and 20% have had bipolar disorder. Most of these individuals smoked cigarettes, and nearly one in five had problems with cocaine and marijuana use. Only 25% ever sought treatment for their problem drinking.

Chronic Severe subtype: 9% of U.S. alcoholics. Comprised mostly of middle-aged individuals who had early onset of drinking and alcohol problems with high rates of Antisocial Personality Disorder and criminality. Almost 80% come from families with multi-generational alcoholism. They have the highest rates of other psychiatric disorders including depression, bipolar disorder and anxiety disorders as well as high rates of smoking and marijuana, cocaine and opiate dependence. Two-thirds of these alcoholics seek help for their drinking problems, making them the most prevalent type of alcoholic in treatment.

The study reported that while seeking help for drinking problems remains rare, attending 12 step programs like Alcoholics Anonymous is the most common form of help-seeking after noticing the symptoms of alcohol use. The authors also noted that co-occurring psychiatric and other substance abuse problems are associated with severity of alcoholism and entering into treatment.

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