What Are the 5 Types of Alcoholics

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Last Updated - 07/05/2024

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Key Takeaways

  • Alcohol use disorder (AUD) is a chronic brain disorder with symptoms such as strong alcohol cravings and withdrawal symptoms.
  • The National Institute on Alcohol Abuse and Alcoholism identifies five subtypes of alcoholics, each with unique characteristics and treatment needs.
  • Young adult alcoholics often require interventions that address peer pressure and life transitions, while functional alcoholics may need support in acknowledging their addiction.
  • Effective treatment for alcoholism often includes a combination of therapy, medication, and support groups, tailored to the individual’s needs.
  • Behavioral therapies like Cognitive Behavioral Therapy (CBT) and contingency management are effective in treating AUD.
  • Medication-Assisted Treatment (MAT) can alleviate withdrawal symptoms and reduce cravings, improving outcomes for individuals with AUD.
  • Support groups such as Alcoholics Anonymous (AA) provide a community of peers which is vital for maintaining sobriety and preventing relapse.
  • Alcoholism has a significant societal and economic impact, including healthcare costs, lost productivity, and social issues.

Understanding Alcoholism: Symptoms, Effects, and Definitions

Alcoholism, also known as Alcohol Use Disorder (AUD), is a medical condition characterized by an inability to manage drinking habits. It is defined by the National Institute on Alcohol Abuse and Alcoholism as a chronic brain disorder marked by the following:

  • Compulsive alcohol use
  • Loss of control over alcohol intake
  • Negative emotional state when not using

Symptoms of AUD

Symptoms of AUD can include the following:

  • Strong craving for alcohol
  • Inability to limit drinking
  • Tolerance to the effects of alcohol
  • Withdrawal symptoms when trying to quit or reduce intake

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the severity of alcoholism is classified into mild, moderate, or severe based on the number of diagnostic criteria met. These criteria include issues such as spending a lot of time obtaining, using, or recovering from the effects of alcohol, and continued drinking despite problems resulting from alcohol use.

Health and Social Consequences of AUD

Alcoholism can lead to numerous health problems, including 

  • Liver disease
  • Cardiovascular issues
  • Mental health disorders

It also has significant social consequences, such as impairing one’s ability to fulfill responsibilities at work, school, or home, and straining relationships. 

Importance of Early Intervention

The Mayo Clinic emphasizes the importance of early intervention to prevent these problems and suggests that treatment can include:

  • Therapy
  • Medication
  • Support groups

Identifying the Five Subtypes of Alcoholism

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has classified alcohol dependence into five distinct subtypes, each with unique characteristics and demographics. Understanding these subtypes is crucial for developing targeted treatment plans and interventions.

  • Young Adult Subtype: This group is the largest, comprising 31.5% of alcohol-dependent individuals. They typically become dependent on alcohol in their early twenties.
  • Young Antisocial Subtype: Members of this subtype often start drinking at a young age and have a higher likelihood of having antisocial personality disorder.
  • Functional Subtype: Functional alcoholics maintain stable jobs and relationships while struggling with their addiction, often in secret.
  • Intermediate Familial Subtype: These individuals often have a family history of alcoholism and may have co-occurring mental health conditions.
  • Chronic Severe Subtype: This is the least common but most severe form, with high rates of co-occurring disorders and the highest levels of psychiatric comorbidity and legal problems.

These classifications help in identifying the various pathways of alcoholism and tailoring treatment accordingly. For instance, young adults may benefit from interventions that address peer pressure and life transitions, whereas functional alcoholics may need support in acknowledging their addiction given their outward appearance of normalcy.

Characteristics and Treatment of Young Adult Alcoholics

Prevalence and Risks

The young adult subtype of alcoholics encompasses individuals aged 18-25, a demographic that exhibits significant rates of alcohol use and binge drinking. Recent data indicates that 15.6% of young adults in the United States meet the criteria for an alcohol use disorder (AUD), with rising levels of alcohol use among females. Notably, 29.2% of young adults reported binge drinking in the past month, and 7.2% engaged in heavy alcohol use, underscoring the prevalence of risky drinking behaviors in this age group.

Treatment Approaches for Young Adult Alcoholics

Effective treatment for young adult alcoholics often requires a multifaceted approach. Evidence-based treatments include the following:

  • Motivational enhancement therapies aim to strengthen internal motivation for change. 
  • Cognitive-behavioral therapies address the psychological aspects of addiction. 
  • Recovery coaching and continuous engagement strategies have been associated with improved retention in care and reduced emergency department use.
  • Comprehensive assessments that consider the individual’s medical, mental health, and psychosocial background are critical for personalizing treatment plans.

Importance of Early Intervention

It is essential for clinicians to address alcohol use early, as delayed intervention can lead to more severe disorders and harm. 

Intervention Types

Interventions that incorporate a motivational interviewing therapeutic style, combined with dialectical behavioral therapy skills, have shown promise for young adults with co-occurring mental health issues. Furthermore, family-based interventions that empower parents as agents of change have demonstrated effectiveness in addressing adolescent substance use.

Understanding the Young Antisocial Alcoholic Subtype

Characteristics of the Young Antisocial Alcoholic Subtype

The young antisocial subtype is a distinct group within the spectrum of alcohol use disorders, characterized by early onset of drinking and a range of antisocial behaviors. According to research, individuals in this subtype are predominantly male and often begin drinking in their mid-teens, with an average onset of alcohol dependence by 18 years old. They frequently exhibit traits associated with antisocial personality disorder (ASPD), including social irresponsibility, exploitive behavior, and a lack of remorse. These individuals may also have a family history of alcoholism, suggesting a genetic component to their condition.

Treatment Approaches for the Young Antisocial Alcoholic Subtype

Effective treatment for the young antisocial subtype involves addressing both the substance use disorder and the underlying antisocial behaviors. A mental health exam is critical in diagnosing ASPD, focusing on thoughts, feelings, relationships, behavior patterns, and family history. Treatment may include:

  • Cognitive-behavioral therapy (CBT) to modify dysfunctional thinking and behavior
  • Medication-assisted treatment (MAT) when appropriate
  • Addressing impulse control and emotional dysregulation for managing the behavioral problems that accompany this subtype

Integrating knowledge of neurobiology and behavioral therapy is important, as antisocial behavior in adolescents is often seen as a neurodevelopmental problem. Given the complexity of the young antisocial subtype, a multifaceted approach that combines behavioral therapies, family involvement, and support systems is recommended to improve treatment outcomes and reduce the risk of relapse.

Understanding the Functional Alcoholic Subtype

The functional alcoholic subtype represents a unique group within the spectrum of alcohol use disorders. Characterized by their middle-aged demographic, this group typically maintains stable jobs and family life while struggling with alcoholism. Approximately 19.5% of American alcoholics fall into this category, often with a well-educated background and a multigenerational family history of alcoholism. While about one-quarter have experienced major depressive illness, nearly half are also smokers, indicating a complex interplay of health issues.

Characteristics of the Functional Alcoholic Subtype

Despite their seemingly stable exterior, functional alcoholics may face significant challenges. They often begin drinking at an average age of 18.5 years and develop alcohol dependence around the age of 37. The onset of alcohol dependence is typically later in life compared to other subtypes, which may contribute to the delay in seeking help. When they do seek treatment, they are more likely to turn to 12-step groups rather than professional or specialty treatment services.

Treatment Approaches for the Functional Alcoholic Subtype

Addressing the needs of functional alcoholics requires tailored interventions:

  • Medical detoxification can provide a safe environment for managing withdrawal symptoms. 
  • Cognitive-behavioral therapy can address both the psychological aspects of addiction.
  • Medication-Assisted Treatment can address both the physical aspects of addiction. 

Moreover, expert staff familiar with the unique challenges faced by this subtype can offer the specialized support needed for recovery. It is vital for treatment plans to consider the individual’s lifestyle, including work and family commitments, to ensure a comprehensive approach that facilitates long-term sobriety.

Understanding the Intermediate Familial Alcoholic Subtype

Characteristics of the Intermediate Familial Alcoholic Subtype

The Intermediate Familial Subtype (IFS) is characterized by a significant family history of alcoholism, often spanning multiple generations. Research indicates that individuals within the IFS are more likely to exhibit symptoms of alcohol dependence when there is a stronger familial link to the condition. The presence of alcoholism in first and second-degree relatives is a common factor among those in the IFS category.

Important Factors of the IFS

Path analyses have shown that environmental factors such as parental rejection, emotional warmth, and peer substance use also play critical roles in the development of alcohol problems in this subtype. Moreover, the IFS is distinguishable by a later onset of alcohol dependence and a higher likelihood of co-occurring psychiatric and substance use disorders compared to other subtypes.

Treatment Approaches for the Intermediate Familial Alcoholic Subtype

Treatment approaches for the IFS often require a multifaceted strategy, addressing not only the individual’s dependency on alcohol but also the broader family dynamics and genetic predispositions. 

  • Behavioral therapies, including cognitive-behavioral therapy and family counseling, are commonly recommended. These treatments aim to modify harmful drinking behaviors and improve family relationships. 
  • Considering the genetic aspects of IFS, medication-assisted treatments that target underlying biological factors may be beneficial. 
  • Support groups can also provide a sense of community and shared experiences, which may be particularly valuable for those with a deep-rooted family history of alcoholism.

Understanding the unique characteristics of the Intermediate Familial Subtype is crucial in developing effective treatment plans that consider both the genetic and environmental aspects of alcoholism.

Addressing the Chronic Severe Subtype of Alcoholism and Co-Occurring Disorders

Characteristics of the Chronic Severe Subtype

The chronic severe subtype of alcoholism is characterized by 

  • high rates of co-occurring mental health disorders 
  • a history of substance abuse 
  • frequent relapses

This group often faces complex challenges requiring integrated treatment approaches that address both the addiction and any accompanying mental health issues. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), integrated treatment strategies are essential for improving outcomes in individuals with co-occurring disorders. SAMHSA’s Treatment Improvement Protocol (TIP) 42 is a resource that guides the treatment of such complex cases.

Treatment Approaches for the Chronic Severe Subtype

Effective treatment plans for the chronic severe subtype often include a combination of:

  • Medication-assisted treatment (MAT)
  • Behavioral therapies 
  • Support services

These are designed to reduce substance use, manage psychiatric symptoms, and facilitate recovery. For instance, cognitive-behavioral therapy can help patients develop coping strategies to deal with triggers for substance use and mental health symptoms. Additionally, peer support and mutual aid groups provide a community of individuals with shared experiences, which can be instrumental in the recovery process.

Screening for Co-Occurring Disorders

Screening for co-occurring disorders is crucial, as it informs the treatment plan and helps providers anticipate and manage symptoms that may arise during recovery. The National Institutes of Health (NIH) highlights the importance of diagnosing co-occurring disorders accurately, as treatment must be tailored to the individual’s specific needs. For those with the chronic severe subtype, long-term treatment goals include sustained abstinence, improved mental health, and a return to functional daily living.

Genetic Factors in Alcohol Use Disorder

Role of Genetics

Alcohol use disorder (AUD) is a condition with complex roots, including genetic predispositions that play a significant role in its development. A study from the Indian Institute of Technology and other institutions has highlighted the high heritability of AUD, pointing to specific genetic markers, such as the rs1229984 single nucleotide polymorphism (SNP) in the ADH1B gene, that are significantly associated with alcohol consumption patterns. These findings underscore the genetic underpinnings that potentially influence an individual’s maximum alcohol intake within a 24-hour period.

Research and Findings

Further research from George Washington University, detailed in a critical review, emphasizes the progress made by genome-wide association studies (GWAS) in identifying genetic variants linked to AUD. These studies also investigate alcohol sensitivity, an endophenotype that could expand our understanding of AUD’s genetic architecture. The genetic components of AUD are broadly categorized into genes that affect the central nervous system’s response to alcohol and those involved in alcohol metabolism.

Connection to Trauma

Moreover, the interaction between genetic predisposition and environmental factors, such as childhood trauma and stress, is also a crucial aspect of AUD’s etiology. This gene-environment interaction suggests that the genetic risk for alcoholism may manifest more strongly in individuals who have experienced significant stress or trauma, particularly in early life. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has been funding studies like the Collaborative Studies on Genetics of Alcoholism (COGA) to further explore these genetic influences.

Influence of Environmental Factors on Alcoholism

Environmental factors play a significant role in the development of alcoholism, with various elements such as upbringing, social influences, and community environments contributing to the risk. 

Young Immigrant Susceptibility

Research indicates that immigrants who arrive in the United States at younger ages are more susceptible to engaging in alcohol use due to greater access and opportunity within certain social networks, alongside potentially weaker parental attachments. This vulnerability is further exacerbated by the higher concentration of liquor stores in minority communities, which increases accessibility to alcohol for these populations.

Timing of Exposure to Environmental Factors

Moreover, the timing of exposure to these environmental factors is crucial, as early life experiences can shape future alcohol consumption patterns. For instance, a younger age of exposure is associated with riskier consumption patterns and consequences. In contrast, older individuals, despite potentially higher consumption frequencies, exhibit better awareness and control over their alcohol intake. Additionally, the influence of religious and cultural environments can also play a role in shaping an individual’s relationship with alcohol.

Interplay of Environment with Other Factors

It is essential to recognize that these environmental influences interact with genetic predispositions, creating complex patterns of alcohol use and misuse among different demographic groups. Therefore, addressing alcoholism effectively requires a comprehensive understanding of the intricate interplay between genetic, social, and environmental factors.

Customized Treatment Approaches for Alcohol Use Disorder

For individuals struggling with alcohol use disorder (AUD), a tailored approach to treatment is crucial due to the diversity of the disorder’s manifestation. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) outlines that treatment often involves a combination of therapy, medications, and sometimes medical devices or apps, with options ranging from inpatient to outpatient settings, and from intensive to more flexible schedules, catering to the individual’s needs, lifestyle, and severity of addiction.

Treatment often involves the following:

  • Therapeutic interventions, such as cognitive-behavioral therapy (CBT), are commonly employed to help patients develop coping strategies, build supportive networks, and establish achievable goals to maintain sobriety. 
  • Medications, such as Acamprosate or Naltrexone, may also be prescribed to manage withdrawal symptoms and cravings. Research has shown that combining behavioral therapy with pharmacotherapy can be more effective than either treatment alone.
  • Aftercare programs are an essential component of the recovery journey, providing ongoing support and resources to prevent relapse. 
  • Support groups like Alcoholics Anonymous (AA) or SMART Recovery offer a community of peers who understand the challenges of maintaining sobriety.

Additionally, healthcare professionals, including psychiatrists, psychologists, and social workers, often play a pivotal role in providing continuous care and guidance.

Effective Behavioral Therapies for Alcoholism Treatment

Behavioral therapies play a crucial role in treating alcoholism by addressing the psychological aspects of addiction. 

  • Cognitive Behavioral Therapy (CBT) is one of the most researched and effective forms of therapy for alcohol use disorders (AUD). CBT focuses on identifying and modifying negative thoughts and behaviors associated with alcohol use, replacing them with healthier patterns. Through guided sessions with a psychologist, patients learn to cope with triggers and develop strategies to maintain sobriety.
  • Contingency management is another approach gaining traction. It incentivizes positive behaviors, such as maintaining abstinence, with rewards. Research, including a systematic review in JAMA Psychiatry, supports its effectiveness.
  • Inclusion of family in treatments like the Youth Opioid Recovery Support (YORS) intervention shows promise in improving outcomes by involving family members in the recovery process.
  • Emerging technologies like virtual reality-assisted CBT are also being explored for AUD treatment, offering immersive environments to practice coping skills. The Frontiers in Psychiatry journal details how such innovations could revolutionize therapy by simulating real-world challenges in a controlled setting.

Behavioral therapies are an integral part of a comprehensive treatment plan that may include medication and support groups, tailored to the individual’s needs.

Understanding Medication-Assisted Treatment for Alcoholism

Medication-Assisted Treatment (MAT) has emerged as a crucial component in the management of Alcohol Use Disorder (AUD), offering a combination of medication and counseling to support recovery. MAT is designed to alleviate withdrawal symptoms, reduce cravings, and improve overall outcomes for individuals struggling with alcoholism. The U.S. Food and Drug Administration (FDA) has approved several medications for the treatment of AUD, including Antabuse (disulfiram), Campral (acamprosate), and oral and injectable forms of Naltrexone.

Flexibility of MAT

Recent updates from the Substance Abuse and Mental Health Services Administration (SAMHSA) highlight the flexibility of MAT, such as take-home doses of methadone and buprenorphine for opioid use disorder, which may also influence approaches to treating AUD. The ability to prescribe medication through telehealth has expanded access to treatment, making it more convenient for patients to receive care.

Promising Research on Medications for MAT

Promising research indicates that medications like Prazosin can significantly reduce or eliminate drinking by targeting different mechanisms in the brain associated with alcohol cravings and withdrawal symptoms. MAT is not a one-size-fits-all solution; it must be tailored to the needs of the individual, taking into account factors such as the subtype of alcoholism and co-occurring disorders. The integration of MAT with behavioral therapies and support systems is essential for a comprehensive approach to treating different types of alcoholics.

For more information on MAT for AUD, visit the SAMHSA guide on medication for the treatment of alcohol use disorder.

The Role of Support Groups in Alcoholism Recovery

Support groups play a crucial role in the recovery process for individuals dealing with alcoholism. These groups provide a platform for mutual support and understanding, which can be vital for maintaining sobriety and preventing relapse. The American Society for Addiction Medicine (ASAM) endorses 12-step programs such as Alcoholics Anonymous (AA) as a key component of recovery, highlighting the importance of community in the healing process.

The Effectiveness of Support Groups

Participation in support groups like AA or Self-Management and Recovery Training (SMART Recovery) has been linked to increased abstinence rates, reduced stress perception, and improved overall quality of life. These groups operate on the premise that recovery is a journey of hope, and witnessing others who have successfully navigated this path can inspire and motivate newcomers.

Support Groups as a Cornerstone of Recovery

While these groups are not a substitute for professional rehabilitation, they complement formal treatment by offering ongoing peer-led support. They are often free and widely accessible, making them an invaluable resource for individuals at various stages of recovery. The core principles of these groups include focusing on recovery, helping others, and providing strength-based support. For many, the shared experiences and wisdom gained through support group participation become a cornerstone of their sustained recovery.

Societal and Economic Impact of Alcoholism

Alcoholism has far-reaching consequences that ripple through society, affecting not just the individual but also the economy, healthcare systems, and community welfare. 

The Economic Burden of Alcoholism

Studies have indicated that the economic burden of alcohol consumption is substantial, with costs stemming from healthcare expenditures, lost productivity, law enforcement, and motor vehicle accidents. For instance, excessive drinking is estimated to cost the United States economy billions annually, with a significant portion due to lost workplace productivity. The Centers for Disease Control and Prevention (CDC) reports that excessive alcohol use led to a median cost of $3.5 billion across states in a single year.

Social Consequences of Alcoholism

Alcohol-related harms extend to societal costs measured by premature deaths, disability-adjusted life years, and the burden on healthcare and criminal justice systems. The social impact begins in the home, with alcohol abuse contributing to intimate partner violence, financial instability, and child neglect and abuse. Fetal alcohol spectrum disorders (FASDs) represent one of the most direct consequences of alcohol consumption during pregnancy, leading to lifelong challenges for affected individuals. 

Research underscores the need for comprehensive strategies that address the multifaceted nature of alcohol-related harm, including prevention, treatment, and support systems.

Alcohol Addiction Treatment at The Recovery Village Indianapolis Drug and Alcohol Rehab

For those seeking alcohol addiction treatment, The Recovery Village Indianapolis Drug and Alcohol Rehab stands as a beacon of hope. Located within the heart of Indy, we offer a comprehensive array of treatment options, including medical detox, inpatient care, partial hospitalization, and intensive outpatient services. 

When you or a loved one are ready to embark on the path to recovery, our Recovery Advocates are here, ready to assist. Reach out to learn more about our tailored treatment programs, designed to cater to your specific needs and situation.


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