Clinicians have been categorizing different types of mental disorders for decades. The current manual for the diagnosis of mental disorders is an attempt to classify and categorize different syndromes of abnormal behaviors or disorders into mutually exclusive groups.
Treatment providers and researchers have attempted to classify different presentations of the same mental disorder that may offer insights into understanding how these disorders develop, how to identify them, and how to design more effective treatment approaches to addressing them. For instance, decades ago, the researcher E.M. Jellinek developed an early classification scheme for individuals who were alcohol abusers, and the scheme is still heavily referenced by the support group Alcoholics Anonymous, although researchers have never been able to verify Jellinek’s alcoholic types.
There have been numerous attempts to develop useful typologies of alcohol abuse presentations that have resulted in different subtypes of individuals who abuse alcohol including models that produce two subtypes, three subtypes, four subtypes, and beyond. Some of these classifications have relied on simple clinical observations, whereas others have relied on statistical methods of data collection, analysis, and classification.
In 2007, a study in the journal Drug and Alcohol Dependence presented a classification of potential different types of individuals with alcohol use disorders based on a structural equation modeling method. The researchers used latent class analysis to classify individuals diagnosed with alcohol dependence into clusters based on:
- The individual’s family history of substance abuse
- The age the individual started using alcohol and the age when they were first diagnosed with a formal alcohol use disorder (alcohol abuse or alcohol dependence)
- Specific information from the individual’s diagnostic profile of alcohol abuse/dependence according to the DSM-IV
- Any history of other mental health disorders
- Any history of additional substance abuse issues to substances other than alcohol
- Basic demographic information, such as the person’s age, gender, etc.
The participants in the study were 1,484 Americans who had a diagnosis of alcohol dependence according to the DSM-IV and who were part of the National Epidemiological Survey on Alcohol and Related Conditions. These types of studies often produce several different models with different groups/clusters.
Researchers using sophisticated techniques, such as latent class analysis, follow a protocol to determine the model that produces the best fit according to the data inputted into the model. The researchers determined that the best-fitting model was one that identified five different clusters or groups of individuals with alcohol dependence. It should be noted that the diagnosis of alcohol dependence is no longer used, and the diagnostic criteria in the DSM-IV have been upgraded and revised in the 2013 DSM-5; thus, this classification system may not be replicated if different individuals diagnosed according to DSM-5 criteria were used.
One of the five subtypes of alcohol dependence produced by the model in this study was the young adult alcoholic subtype.
Characteristics of the Young Adult Alcoholic Subtype
The overall profile of the young adult alcoholic subtype is outlined below.
- The individuals were mostly male.
- These individuals were mostly younger, with an average age of around 25.
- The group had an early onset of alcohol dependence; the mean age for the diagnosis of alcohol dependence was 19.6 years in this group.
- There was a moderate probability that individuals in this group had first-degree or second-degree relatives with a diagnosis of alcohol dependence (about half of the group).
- There was a moderate probability that individuals in this group either use tobacco or cannabis products.
- Individuals in this group were likely to use alcohol in dangerous or hazardous situations.
- Individuals in this group were likely to experience physical dependence on alcohol.
- Individuals in this group had a low probability of having co-occurring mental health disorders compared to the other groups generated by the model.
- Individuals in this group had a relatively low probability of seeking out treatment for their alcohol abuse on their own.
About 21 percent of the sample was classified in this cluster. Some sources often incorrectly say that 21 percent of Americans were classified into this cluster; however, that type of comparison is inappropriate given the method by which the sample was generated. These individuals often resort to binge drinking and do not drink as frequently as individuals in the other groups/clusters. The individuals from this cluster who did seek treatment generally preferred 12-Step groups to therapy or other private forms of treatment.
There were no associations that could be interpreted as being causal factors associated with this group’s alcohol abuse, and the nature of the type of research that was used to develop this model would not allow the research to make any type of causal inferences anyway. Thus, resources that have pointed to individuals with positive family histories of substance abuse and early onset of a diagnosis, etc., as causal factors are making inappropriate assumptions about the results of this data.
What Does This Information Tell Us?
It is doubtful that these types of studies offer any incremental or additional diagnostic utility to the process used by APA to identify alcohol use disorders and other problems associated with alcohol use in individuals. For example, even though the study was released in 2007, the researchers did a follow-up study to follow their participants and describe how they had progressed in 2010. Other models of alcohol use disorders have been generated with different groups/classifications, and the diagnostic criteria for alcohol use disorders presented in 2013 in the DSM-5 does not identify any subtypes of alcohol use disorders other than individuals who have mild, moderate, or severe alcohol use disorders. The designation of the severity of an individual’s alcohol use disorder is based on the number of symptoms/diagnostic criteria that they meet, with individuals satisfying more symptoms being diagnosed with more severe manifestations of alcohol abuse.
However, some general associations from this study and similar studies, along with information provided in the DSM-5 and other clinical sources, can allow one to generalize some specific risk factors for developing issues with alcohol abuse at an early age.
- Individuals who have a family history of substance abuse issues are at an increased risk to develop a substance use disorder. This is a general risk factor described in numerous references.
- Individuals who have a family history of substance abuse, have significant dysfunctional issues with their own alcohol abuse at an early age, are males, and use alcohol in situations where it may be hazardous to do so may be more likely to develop physical dependence on alcohol.
- Younger male individuals with an early onset of alcohol abuse issues may need to be coaxed into seeking out treatment for these issues.
- Younger male individuals with an early onset of alcohol abuse issues and a family history of alcohol abuse may prefer treatment situations where individuals are treated in groups and there are open discussions.
Again, it is important to understand that any of the above observations do not represent cause-and-effect observations. Given the above information, we would expect that individuals who are male, younger, and have an early age of a diagnosis of an alcohol use disorder might benefit from initial treatment in a withdrawal management program (medical detox) to help them deal with withdrawal symptoms that may increase the risk for relapse. These individuals may actually be living with a relative who has a substance use disorder, and it may be prudent to attempt to initially place these individuals in inpatient or residential treatment to isolate them from potentially toxic environmental conditions.
Getting individuals with similar profiles into treatment may be difficult, and the use of a substance use disorder intervention, mandatory treatment as a condition of employment or to avoid legal issues, or some other means to initiate treatment for the individual will most likely be more successful than waiting for them to volunteer for treatment on their own. It should be noted that, according to the National Institute on Drug Abuse (NIDA), the success rates for individuals with substance use disorders who volunteer for treatment or are forced into treatment are equivalent.
Treatment for these individuals should be very structured and offer significant social support while at the same time allowing these individuals to feel like they have some degree of control of their own treatment protocol (such as what occurs in 12-Step groups like Alcoholics Anonymous). Efforts to get these types of individuals into substance use disorder therapy might be more successful if the individuals can receive psychotherapy in a group format where there are others with similar backgrounds. As these individuals begin to interact in these groups, the therapists can suggest that they enter individual therapy sessions if it is deemed they would also be beneficial.
These individuals may respond very well to treatment programs that include a significant psychoeducational component to them. In addition, medical management and treatment for any co-occurring conditions, such as a cannabis use disorder, tobacco use disorder, etc., should be initiated along with the treatment for their alcohol use disorder. Personal responsibility to remain in treatment and to practice the principles learned in treatment should be stressed.