What Are the 5 Types of of Alcoholic Subtypes?
Over 6 percent of American adults battled an alcohol use disorder (AUD) in 2015, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) publishes. Less than 10 percent of adults in the United States who struggled with alcoholism in 2015 received professional treatment for the disease, NIAAA further reports. There are many possible reasons for this treatment gap.
One such issue is that of a perceived need for professional help and recognition that a problem with alcohol exists. In 2013, the National Survey on Drug Use and Health (NSDUH) reported that of those who needed treatment and didn't receive it, approximately 95.5 percent didn't feel they needed it. This idea may be perpetuated if a person doesn't fit into the role of the stereotypical "alcoholic." When a person is educated, has a stable home life, holds down a job, and has no family history of alcoholism, it may be difficult for them to accept that their drinking is problematic. The alcoholic label may not seem to fit. Families may be more willing to overlook excessive drinking and issues related to alcohol abuse if their loved one appears to be functional in other areas or does not fit into the commonly perceived idea of what an alcoholic should look like.
Researchers at NIAAA, part of the National Institutes of Health (NIH), have identified five different subtypes of alcoholics to help people gain a better understanding of the disease. The five types are:
- Young adult subtype
- Young antisocial subtype
- Functional subtype
- Intermediate familial subtype
- Chronic severe subtype
By gaining a better understanding of the different types of alcoholics, a person can better learn how alcoholism may affect them personally, helping them to then locate a relevant treatment program and learn how to manage their alcoholism into recovery.
Young Adult Alcoholics
The largest percentage of alcoholics fall into this group, as NIAAA publishes that 31.5 percent of all alcoholics in the United States fit this subtype. This group is typically in their late teens or early 20s, and either just of legal drinking age or slightly younger. Many young adult alcoholics are likely college students who are away from home for the first time, and who are surrounded by a culture that promotes and encourages excessive social drinking.
The Centers for Disease Control and Prevention (CDC) reports that underage drinkers between the ages of 12 and 20 regularly consume more alcohol at a time than older drinkers, and 90 percent of the alcohol consumed by this group is through binge drinking.
Binge drinking is a pattern of drinking, often perpetuated by underage and young adult drinkers, where they bring their blood alcohol concentration (BAC) up to or above 0.08 g/dL, which often occurs in the span of two hours when a man has five drinks or a woman has four, NIAAA explains.
NIAAA reports on a national survey that found that 60 percent of college students between the ages of 18 and 22 drank alcohol in the past month, and nearly two out of every three of these students binge drank during that month. Binge drinking is a pattern of excessive alcohol use that increases the risk for developing tolerance and then physical dependence on alcohol that can then lead to addiction. According to NIAAA, around 20 percent of college students struggle with alcohol addiction.
The young adult alcoholic may not seek help for their problematic drinking, as drinking to excess at this age is often considered "normal" and part of a phase of life. Family members and adults may assume that the young adult will then "grow out of it" and do not see the drinking as a potential ongoing or long-lasting issue.
People who fall into the young adult alcoholic subtype also rarely have a family history of alcoholism. Alcoholism is considered to be a heritable disease, as NIAAA reports that genetics can account for about half of the risk for developing the disease. The flip side of this coin, however, is that environmental and other factors make up the other half of the risks for the onset of addiction. Drinking to excess on a regular basis, living in a pro-drinking environment, peer pressure, drinking before the brain is fully formed in early adulthood, and abusing other drugs with alcohol can all contribute to the onset of alcoholism, just as biology and genetics can.
Nearly one-third of all alcoholics fit into the young adult alcoholic subtype.
Young Antisocial Alcoholics
This subtype of alcoholics is generally in their mid-20s and started drinking young. Early episodes of binge and heavy drinking (binge drinking on five or more days in the same month) can elevate the risk for struggling with alcohol-related issues later in life.
Alcohol impacts brain chemistry, and regular exposure to the mind-altering substance may actually change the way the brain's circuitry works. An individual may then suffer from cravings and withdrawal symptoms when alcohol isn't active in the bloodstream, encouraging the person to drink more to feel better.
Young brains do not have a fully developed prefrontal cortex, meaning that young people may have more difficulties controlling emotions and impulses, and are therefore more likely to take bigger risks without fear of consequences. Excessive drinking can be a particularly risky behavior, especially when undertaken by young people, as it may interfere with normal brain growth and development, and make the person more likely to struggle with substance abuse and addiction later in life, the National Institute on Drug Abuse (NIDA) warns. The CDC reports that consuming alcohol prior to age 15 increases the odds that a person will suffer from alcohol abuse or addiction later in life, up to six times more than a person who waits to drink until they are of the legal drinking age of 21.
More than half of young antisocial alcoholics have a family history of alcoholism, and around half also struggle with antisocial personality disorder. When a person suffers from a co-occurring mental health disorder, the risk for also developing alcoholism or problems with substance abuse are elevated. The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that co-occurring mental health disorders and addiction are common, as about 8 million adults in America battled both in 2014.
Antisocial personality disorder commonly co-occurs with alcohol abuse, as alcohol can lower social inhibitions and anxiety, and make a person feel more relaxed. Drinking may then be used as a method of self-medicating the personality disorder symptoms. People who suffer from antisocial personality disorder also typically struggle with poor impulse control, which may then make them more vulnerable to participate in risky and problematic drinking, and other self-destructive behaviors.
Many people who fall into the young antisocial alcoholic subtype suffer from other mental health disorders as well, such as bipolar disorder, anxiety disorders, or depression. As many as three-fourths of this subset also smoke marijuana and/or cigarettes, and many also struggle with opioid or cocaine addictions as well. Polydrug abuse, and co-occurring disorders combined with alcohol abuse, increases the risk for addiction and can interfere with treatment measures. Around one-third of young antisocial alcoholics will seek treatment for problematic drinking.
This subtype of alcoholics is typically middle-aged, well-educated, and may seem to have it all "together" on the outside. They are likely have a steady job, a seemingly stable family life, and do not often fit into the traditional stereotype of an alcoholic.
Around 19.5 percent of the alcoholic population in the United States falls into the functional alcoholic subtype. Someone who is considered a functional alcoholic may lead a kind of double life, compartmentalizing their drinking from the rest of their life. Unlike the typical alcoholic, a functional alcoholic will probably fulfill most of their regular obligations on a consistent basis, and family members may enable their drinking by making excuses for them when issues related to alcohol abuse do come up.
A functional alcoholic may not hit "rock bottom," and they are often successful in relationships, employment, and life in general. Therefore, Psychology Today reports that they often deny they have a problem with alcohol and are less likely to seek professional help.
About half of this subtype of alcoholics smoke cigarettes, and one-third have a family history of alcoholism. Around one-quarter of the functional alcoholic demographic have had at least one major depressive episode in their lives as well. Depression and mood disorders commonly co-occur with alcohol abuse and can increase a person's vulnerability to addiction. The functional alcoholic may be good at covering up emotional distress and issues with alcohol, and able to maintain outward appearances of success.
Intermediate Familial Alcoholics
Making up 19 percent of all American alcoholics, the intermediate familial alcoholic will typically be middle-aged and come from a family with multigenerational alcoholism about half of the time. Most intermediate familial alcoholics smoke cigarettes and close to one out of every five also struggles with marijuana and cocaine abuse. Abusing more than one substance at a time, such as alcohol and cocaine, increases all of the potential side effects and risk factors associated with each substance on its own, and also raises the risk that a person will then develop an addiction to one or both substances as well.
Nearly half of all intermediate familial alcoholics have struggled with clinical depression, and 20 percent have battled bipolar disorder. These disorders often co-occur with alcoholism. Alcohol may become a method of self-medicating the difficult emotional symptoms of depression and the mood swings associated with bipolar disorder. Essentially, alcohol changes brain chemistry and increases the presence of dopamine, which makes a person feel happy and relaxed.
Co-occurring disorders are optimally treated with an integrated program that can help to manage both disorders at the same time. Around one-quarter of intermediate familial alcoholics seek treatment for drinking-related problems.
Chronic Severe Alcoholics
Most likely what a person pictures when the term alcoholic is used, the chronic severe alcoholic subtype only accounts for about 9 percent of the entire US alcoholic population. A chronic severe alcoholic likely started drinking and struggling with alcohol-related issues and problematic drinking at a young age and is currently middle-aged. This subtype also battles antisocial personality disorder at high rates and regularly has issues with the law and therefore criminal or legal troubles as well.
Alcohol is often implicated in exacerbating aggression, and the National Council on Alcoholism and Drug Dependence (NCADD) publishes that 40 percent of all violent crimes cite alcohol as a contributing factor. Chronic severe alcoholics suffer from psychiatric disorders more often than other subtypes of alcoholics, including bipolar disorder, depression, and anxiety disorders.
Close to 80 percent of chronic severe alcoholics have a genetic and familial link to alcoholism, meaning that a close family member also suffered, or suffers, from alcoholism. Chronic severe alcoholics abuse other drugs at higher rates than the other subtypes of alcoholics as well.
Chronic severe alcoholics often smoke and may also suffer from cocaine, opioid, and/or marijuana dependence in addition to alcohol addiction. Chronic severe alcoholics often experience severe life problems related to their drinking, such as homelessness, loss of a job, dissolution of a relationship, legal problems, health issues, and other social, emotional, and behavioral concerns that may make them more likely to seek professional help. This subtype of alcoholics is the most likely to seek treatment and the most heavily represented type of alcoholic in a treatment program. About two-thirds of chronic severe alcoholics get help for their drinking.
Determining Your Alcoholic Type
Alcohol is the most common addictive substance abused in America today. NCADD reports than one out of every 12 adults struggles with alcohol abuse, dependence, or addiction. NIDA publishes the 11 signs of addiction that the Diagnostic and Statistical Manuel of Mental Disorders (DSM-5) lists as being indicators of the disease. These include:
- Difficulties stopping drinking once you start and trouble controlling how often you drink
- Making multiple attempts to stop drinking and being unsuccessful despite wanting to stop
- Experiencing cravings for alcohol
- Spending a lot of time getting alcohol, consuming it, and recovering from its aftermath
- Continuing to drink even though it damages relationships and social interactions
- Drinking interfering with fulfilling regular life obligations
- Giving up activities and recreational events for alcohol
- Drinking alcohol in situations where it is physically dangerous or risky to do so
- Continuing to drink even when you know that it will cause physical, emotional, social, or other issues
- Tolerance to alcohol as indicated by the need to drink more to feel “normal”
- Withdrawal symptoms when alcohol wears off and in between episodes of drinking
The presence of any two symptoms within a one-year period can result in a diagnosis of alcohol addiction. As previously mentioned, however, there are multiple types of alcoholic subtypes. The following checklists for each type can help you determine which subtype you might fall into.
Young adult alcoholic
- You are probably close to the legal drinking age of 21.
- You might be a college student.
- You most likely do not suffer from co-occurring disorders.
- You probably do not have a family history of alcoholism.
- You may not see drinking as problematic or seek help for drinking.
Young antisocial alcoholic
- You are in your mid-20s.
- You started drinking and experiencing alcohol-related issues at a young age.
- You may have a close family member who struggles with alcoholism.
- You are likely to also suffer from antisocial personality disorder.
- You may struggle with depression, an anxiety disorder, or bipolar disorder.
- You probably smoke cigarettes and/or marijuana.
- You may also battle cocaine and/or opiate dependence.
- You are middle-aged and likely well-educated, gainfully employed, and successful.
- You probably have a family and few issues maintaining relationships.
- You may suffer from denial that your drinking is problematic as you are able to compartmentalize your drinking life.
- Family members and/or spouses may make excuses for your drinking since you are able to consistently be a provider and fulfill your regular obligations.
- When you do drink, however, you may be unable to stop and commonly drink more than you meant to in a sitting. You probably struggle with cravings for alcohol.
- You may make many excuses to drink and/or replace meals with alcohol.
- You may suffer from blackouts and drink to excess socially on a regular basis.
- You are likely to have suffered from an episode of major depression at some point in your life.
- You may smoke cigarettes.
Intermediate familial alcoholic
- You are middle-aged.
- You are likely to have a close family member who struggles with alcoholism.
- You may also struggle with clinical depression and possibly with bipolar disorder.
- You probably smoke cigarettes.
- You also are highly likely to abuse cocaine and/or marijuana as well.
Chronic severe alcoholic
- You are middle-aged, and started drinking and engaging in problematic drinking habits early in life.
- You come from a home where a close family member probably struggled with alcoholism.
- You have a hard time keeping a job, a house, or a relationship.
- You are likely to have legal issues and may engage in criminal behaviors.
- You probably also struggle with antisocial personality disorder and other psychiatric disorders, such as an anxiety disorder, depression, or bipolar disorder.
- You probably also smoke cigarettes and marijuana, and may battle cocaine and opioid dependence.
- You are likely to seek help for your drinking and may have already been through a treatment program.
By having a better understanding of what type of alcoholic you may be, it can be easier to recognize that you would benefit from an alcohol addiction treatment program. Treatment providers can help you to determine what form of treatment will be optimal for your specific needs and circumstances. Alcoholism is a manageable disease; treatment is necessary to manage it.