Different Types Of Alcoholics
Discover the diverse types of alcoholics - from young adults to chronic severe cases. Get insights into treatment and predicting relapse.
Dr. Deyhimy MD
April 11, 2024
Discover the diverse types of alcoholics - from young adults to chronic severe cases. Get insights into treatment and predicting relapse.
Alcohol use disorder (AUD) is a chronic condition characterized by an individual's inability to control or stop their alcohol consumption despite negative consequences. It is a serious public health concern that affects a significant portion of the population.
According to Alcohol.org, over 6 percent of American adults battled an alcohol use disorder in 2015. AUD encompasses a range of behaviors and symptoms, including a strong urge to drink, difficulty cutting down or stopping alcohol consumption, and continued alcohol use despite adverse effects on relationships, work, and overall well-being.
Researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have identified five different subtypes of alcoholics, each with unique characteristics and patterns of alcohol use:
Young Adult Alcoholics make up the largest percentage of alcoholics in the United States, accounting for 31.5 percent of the alcoholic population [1]. This subtype is typically characterized by early-onset drinking, a high prevalence of binge drinking, and a higher likelihood of co-occurring mental health disorders.
Young Antisocial Alcoholics, comprising approximately 21 percent of alcoholics, often exhibit antisocial behavior and engage in substance abuse during adolescence. They may also have a higher risk of legal problems and co-occurring psychiatric disorders.
Functional Alcoholics, who make up 19.5 percent of the alcoholic population, typically lead seemingly stable lives and may not fit into the traditional stereotype of an alcoholic. They are often able to maintain jobs, relationships, and responsibilities while continuing to consume alcohol.
Intermediate Familial Alcoholics have a strong family history of alcoholism and account for approximately 19 percent of alcoholics. They are more likely to have close relatives with severe alcohol problems and often develop AUD at a younger age.
Chronic Severe Alcoholics, the smallest subtype at 9 percent, often have a long history of heavy drinking and experience significant physical and psychological consequences as a result of their alcohol misuse. They may exhibit withdrawal symptoms and require intensive treatment and support to address their alcohol use disorder.
Understanding the different subtypes of alcoholics can help tailor treatment approaches and interventions to meet the specific needs of individuals struggling with alcohol use disorder. It is important to recognize that each individual's experience with AUD is unique, and treatment should be personalized to address their specific challenges and circumstances.
Alcohol use disorder is a complex condition that can manifest in various ways. Understanding the different subtypes of alcoholics can provide insights into the unique characteristics and treatment needs of individuals struggling with alcohol dependence. Here, we will explore five subtypes of alcoholics: young adult alcoholics, young antisocial alcoholics, functional alcoholics, intermediate familial alcoholics, and chronic severe alcoholics.
The Young Adult subtype is the largest group, accounting for approximately 31.5% of alcoholics. Members of this group typically start drinking at around 19 years old and develop alcohol dependence by around 24. They have lower rates of co-occurring mental health conditions compared to other subtypes and moderate rates of other substance abuse disorders. This group is more likely to consist of males and is less likely to seek treatment. However, if they do seek help, they are more inclined to choose a 12-Step program.
The Young Antisocial subtype comprises approximately 21.1% of alcoholics. Individuals in this group tend to start drinking at a younger age, around 15, and develop alcohol dependence by around 18. More than 50% of this subtype exhibit traits of antisocial personality disorder. They have high rates of depression, other substance abuse disorders, and are more likely to seek help compared to other subtypes. Around 35% of young antisocial alcoholics seek assistance in overcoming alcoholism.
The Functional subtype represents about 19.5% of alcoholics. Individuals in this group typically start drinking at around 18 and develop alcohol dependence by around 37. Despite their alcohol dependence, they are able to maintain jobs and relationships. The functional subtype has moderate rates of depression and is more likely to smoke cigarettes. However, they have fewer other substance use disorders. This group tends to have higher education levels and incomes compared to other subtypes. Less than 20% of functional alcoholics seek help, with many opting for a 12-Step program or seeking assistance from private healthcare professionals.
The Intermediate Familial subtype is characterized by a family history of alcoholism. It represents a smaller percentage of alcoholics compared to other subtypes. Individuals in this group may have a family history of alcoholism and tend to start drinking at an intermediate age. They have higher rates of co-occurring mental health disorders and other substance abuse. Seeking help for alcoholism is more common among intermediate familial alcoholics, with treatment often involving a combination of therapy and support groups.
The Chronic Severe subtype is the smallest group, consisting of approximately 9.2% of alcoholics. Individuals in this group typically start drinking at a younger age, around 15, and develop alcohol dependence by around 29. More than 80% of chronic severe alcoholics experience acute alcohol withdrawal symptoms and show persistent efforts to cut down on their drinking. They have high rates of other mental health disorders and substance abuse. Two-thirds of this subtype seek help for alcoholism at some point, making them the most likely group to do so.
Understanding the different subtypes of alcoholics can assist healthcare professionals in tailoring treatment approaches to meet the specific needs of individuals struggling with alcohol use disorder. By considering the characteristics and unique challenges associated with each subtype, healthcare providers can offer more effective and personalized interventions for individuals seeking help in overcoming alcoholism.
Understanding the different types of alcoholics is crucial in comprehending the complexities of alcohol use disorder and tailoring appropriate treatment approaches. The history of alcoholism typology can be divided into three periods: the prescientific period, the Jellinek era, and the post-Jellinek era.
During the prescientific period (1850–1940), typologies were developed primarily based on clinical observation, anecdotal evidence, and intuition. However, it was E.M. Jellinek who made significant contributions to the field by creating the first scientific typology of alcoholism. Jellinek's work laid the foundation for understanding the different subtypes of alcoholics.
E.M. Jellinek proposed a typology of alcoholism that included five types: alpha, beta, gamma, delta, and epsilon. Among these types, gamma and delta were considered true disease entities. Gamma alcoholics were characterized by drinking due to psychological vulnerability, while delta alcoholics consumed alcohol due to social and economic influences. Jellinek's typology provided a framework for understanding the various manifestations of alcohol use disorder.
In the post-Jellinek era (1960–present), typology research shifted towards empirical studies and the development of multidimensional typologies. Researchers began identifying various subtypes of alcoholics based on defining characteristics such as gender, family history, coexisting psychopathology, and age of onset. This approach allowed for a more comprehensive understanding of the factors contributing to alcohol use disorder.
Modern typology research aims to refine and expand upon previous typologies, taking into account the complexities of alcohol use disorder. This includes examining genetic factors, environmental influences, and the interplay between biological, psychological, and social aspects. By understanding the different typologies, researchers and healthcare professionals can better tailor treatment approaches and support systems for individuals struggling with alcoholism.
The study of alcoholism typologies has evolved over the past century and a half, contributing to a better understanding of the etiology of alcoholism, improving treatment strategies, and advancing the theoretical framework surrounding alcoholism and its consequences. It is an ongoing area of research that continues to shed light on the complexities of alcohol use disorder and guide efforts to support those in need.
When examining alcohol use disorder, it is important to understand the behavioral and personality traits commonly associated with individuals who struggle with alcohol addiction. Recognizing these characteristics can help identify and address the underlying issues associated with alcoholism.
Several behavioral traits are often observed in individuals with alcohol use disorder. These traits may vary from person to person, but they provide important insights into the nature of their addiction:
Prioritizing alcohol: Alcoholic individuals may prioritize drinking over other activities and relationships in their life, sometimes feeling uncomfortable without alcohol present. This prioritization can indicate a physical dependency on alcohol, leading to continued drinking.
Placing blame on others: Alcoholics may exhibit a tendency to shift responsibility for their actions onto external factors such as coworkers, housemates, or relatives. This behavior often stems from problematic behavior resulting from substance abuse, leading them to deflect accountability.
Making frequent excuses: Another common characteristic of alcoholics is making frequent excuses to justify excessive drinking. These excuses may be related to work stress, relationship difficulties, or celebrations, and are often used to avoid accountability for their drinking habits.
Drinking uncontrollably: Alcoholics struggle with regulating their alcohol intake, leading to excessive drinking even in social situations. This lack of control may indicate a physical and psychological urge to consume alcohol.
Financial struggles: Alcohol addiction can lead to financial instability due to the high cost of alcohol, impaired work performance, and potential job loss or decreased wages resulting from being intoxicated at work.
In addition to behavioral traits, certain personality traits are often associated with individuals who struggle with alcohol use disorder. These traits may include:
Impulsivity: Many alcoholics exhibit impulsive behavior, often acting without considering the consequences. This trait can contribute to the development and maintenance of alcohol addiction.
Low self-esteem: Individuals with alcohol use disorder may struggle with low self-esteem and feelings of inadequacy. They may turn to alcohol as a means of coping with these negative emotions.
Emotional instability: Alcoholics often experience emotional instability, which can manifest as mood swings, irritability, and difficulty managing anger.
Sensitivity to stress: Alcoholics may have a heightened sensitivity to stress and may turn to alcohol as a way to temporarily alleviate or escape from stressful situations.
Risk-taking behavior: Many alcoholics engage in risky behavior, such as driving under the influence or engaging in unsafe sexual practices. This behavior may be a result of impaired judgment while under the influence of alcohol.
Understanding these behavioral and personality traits can assist in the identification, intervention, and treatment of alcohol use disorder. It is important to approach individuals struggling with alcohol addiction with empathy and support, encouraging them to seek professional help and providing resources for recovery.
When it comes to addressing alcohol use disorder, there are various treatment options available to individuals seeking help. These treatments aim to assist individuals in overcoming their alcohol dependence and achieving long-term recovery. Here, we will explore three key aspects of alcohol use disorder treatment: levels of care, evidence-based approaches, and support groups and alternatives.
The American Society of Addiction Medicine defines four basic levels of care or intensity for alcohol treatment NIAAA. These levels include:
Early Intervention: This level of care focuses on identifying and addressing alcohol-related issues at an early stage. It may involve brief interventions, education, and guidance to help individuals reduce their alcohol consumption and prevent the progression of alcohol use disorder.
Outpatient Treatment: Outpatient treatment allows individuals to receive care while living at home and continuing with their daily activities. It typically involves counseling, therapy sessions, support groups, and medication management. This level of care is suitable for individuals with less severe alcohol use disorder and a strong support system.
Intensive Outpatient/Inpatient Treatment: For individuals with moderate to severe alcohol use disorder, intensive outpatient or inpatient treatment may be necessary. These programs provide more structured and comprehensive care, including individual and group therapy, medical supervision, and access to specialized treatment modalities. Inpatient treatment involves residing at a treatment facility, while intensive outpatient programs offer more flexibility.
Residential/Inpatient Treatment: This level of care is designed for individuals with severe alcohol use disorder who require round-the-clock care and supervision in a residential setting. It offers a highly structured environment, detoxification services, intensive therapy, and medical support to address the complex needs of individuals struggling with alcohol addiction.
Treatment approaches for alcohol use disorder should be "evidence-based," meaning they are supported by large, well-designed studies NIAAA. These evidence-based approaches include:
Medication-Assisted Treatment (MAT): Medications, such as naltrexone, acamprosate, and disulfiram, may be prescribed to help individuals reduce alcohol cravings, manage withdrawal symptoms, and maintain sobriety. These medications are often used in combination with counseling and behavioral therapies to enhance treatment outcomes.
Cognitive-Behavioral Therapy (CBT): CBT is a widely used therapeutic approach that focuses on identifying and modifying unhealthy thoughts and behaviors related to alcohol use. It helps individuals develop coping skills, build resilience, and develop strategies to prevent relapse.
Motivational Enhancement Therapy (MET): MET is a goal-oriented counseling approach that aims to increase an individual's motivation to change their drinking behavior. It involves assessing and reinforcing internal motivation, exploring ambivalence, and setting achievable goals.
Contingency Management: Contingency management utilizes positive reinforcement to encourage individuals to abstain from alcohol. It involves providing rewards, such as vouchers or privileges, for achieving treatment goals, such as attending therapy sessions or passing drug tests.
Alongside professionally led treatment, mutual support groups play a significant role in helping individuals with alcohol problems NIAAA. These groups provide a supportive environment where individuals can connect with others facing similar challenges, share experiences, and receive encouragement. Examples of support groups for alcohol use disorder include Alcoholics Anonymous (AA) and SMART Recovery.
In addition to traditional treatment and support groups, alternative options are available for individuals seeking alcohol treatment. These alternatives can complement or serve as standalone options, depending on individual needs. Some alternatives include:
Building a Custom Care Team: Creating a personalized care team consisting of healthcare professionals, therapists, and supportive individuals who can provide guidance and support throughout the recovery journey.
Telehealth Services: Utilizing telehealth services, such as phone or video sessions, to receive counseling and therapy remotely. This offers convenience and accessibility, particularly for individuals with limited mobility or those residing in remote areas.
eHealth Options: Engaging with online or mobile tools specifically designed for alcohol treatment, such as self-help programs, interactive modules, and digital resources. These resources can provide education, coping strategies, and tracking tools to support individuals in their recovery efforts.
It's important for individuals to explore various treatment options, considering their unique needs and preferences. A combination of professional care, evidence-based approaches, and support from peers can significantly enhance the chances of successful recovery from alcohol use disorder.
When it comes to alcohol use disorder, predicting the risk of relapse is a crucial aspect of treatment and recovery. Several factors contribute to the likelihood of relapse, including clinical factors, biological measures, and psychological factors. Understanding these risk factors can help inform treatment and support strategies for individuals dealing with alcoholism.
Clinical factors encompass a range of patient-related factors and subjective and behavioral measures that can predict future relapse risk. Some of these factors include depressive symptoms, stress levels, and drug craving [5]. Higher depression scores have been shown to be associated with shorter time to relapse and a lower likelihood of abstinence. Additionally, higher levels of craving during abstinence and in outpatient treatment are known predictors of relapse.
Biological measures also play a role in predicting the risk of relapse among individuals with alcohol use disorder. Endocrine measures, such as cortisol levels and the cortisol/corticotropin (ACTH) ratio, can serve as indicators of adrenal sensitivity and future relapse risk. Serum brain-derived neurotrophic factor, a protein involved in the growth and survival of neurons, has also been identified as predictive of relapse risk.
Psychological factors, including stress and trauma, have a significant impact on the risk of relapse. Exposure to stressors in the laboratory, such as guided imagery stress scripts or systemic injections of the stress hormone corticotropin-releasing factor (CRF), have been shown to increase drug craving. Stress and trauma are associated with increases in irritability, anxiety, emotional distress, sleep problems, dysphoria, aggressive behaviors, and drug craving, which can contribute to the risk of relapse.
Understanding these clinical, biological, and psychological factors can help healthcare professionals develop personalized treatment plans for individuals with alcohol use disorder. By addressing these risk factors and implementing evidence-based approaches, such as cognitive-behavioral therapy and medication-assisted treatment, the chances of successful recovery and reduced risk of relapse can be improved.
It's important to note that relapse is a common occurrence in substance abuse treatment, with more than 85% of individuals relapsing within one year of treatment. However, with ongoing support, relapse prevention strategies, and a comprehensive treatment approach, individuals can work towards long-term recovery and reduce the impact of alcohol use disorder on their lives.
Dr. David Deyhimy, with over 20 years of experience, is a board-certified physician in addiction medicine and anesthesiology based in Orange County.
Don’t hesitate to contact us today with any questions you may have about our program or if someone you know is struggling with addiction.
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