When people hear the word “alcoholism,” they often think of someone who drinks excessively and can’t stop. However, alcohol use disorder (AUD) is much more complex. Research has shown that there are distinct subtypes of alcoholism, each with its own patterns of drinking, underlying causes, and co-occurring behaviors. Understanding these subtypes can help tailor treatment options more effectively. In this article, we’ll explore the different types of alcoholism, from functional drinkers to those struggling with severe addiction.

1. Young Adult Subtype

The young adult subtype is one of the most common forms of alcoholism, accounting for about 31% of alcoholics. These individuals are usually in their late teens or early twenties and often begin drinking at a young age. While they may not drink as frequently as others, they tend to engage in binge drinking, consuming large amounts of alcohol in one sitting.

Key characteristics:

Start drinking early

Frequently engage in binge drinking

Often do not seek help or recognize their drinking as problematic

Less likely to have co-occurring mental health disorders

Despite their heavy drinking, people in this subtype often do not realize that their behavior constitutes alcohol dependence, which makes them resistant to treatment.

Source: Moss, H. B., Chen, C. M., & Yi, H. Y. (2007)

2. Young Antisocial Subtype

The young antisocial subtype is typically younger (average age 26) and is characterized by a strong family history of alcoholism. These individuals often exhibit antisocial behaviors and are more likely to suffer from mental health issues such as depression, anxiety, or other substance use disorders.

Key characteristics:

High rate of co-occurring psychiatric disorders

Likely to have family members who struggle with alcohol dependence

Early onset of drinking and addiction issues

This group makes up about 21% of alcoholics and often requires intensive intervention, as they face compounded challenges of mental health disorders and alcohol dependence.

Source: Moss, H. B., Chen, C. M., & Yi, H. Y. (2007)

3. Functional Subtype

Contrary to popular stereotypes, not all alcoholics fit the image of someone whose life is falling apart. The functional subtype consists of individuals who maintain jobs, relationships, and appear to have their lives under control despite being alcohol dependent. These drinkers often lead double lives, excelling in their careers while hiding their addiction.

Key characteristics:

Typically middle-aged, successful in their careers

Drink almost daily but maintain a facade of normalcy

Few obvious signs of addiction

Functional alcoholics may go undiagnosed for years, making this one of the most insidious types of alcoholism. This subtype represents about 19% of all alcoholics.

Source: Schuckit, M. A. (2009)

4. Intermediate Familial Subtype

The intermediate familial subtype is typically middle-aged and shares a strong genetic predisposition to alcoholism. Many in this group have immediate family members who also struggle with alcohol dependence. They are often moderately severe in their drinking and may suffer from other substance use disorders as well.

Key characteristics:

Family history of alcoholism

Often drink to cope with stress or anxiety

High likelihood of co-occurring disorders, such as depression

This group accounts for about 19% of alcoholics and often responds well to treatment programs that address both the genetic and emotional roots of their addiction.

Source: Cloninger, C. R., Bohman, M., & Sigvardsson, S. (1981)

5. Chronic Severe Subtype

The chronic severe subtype is the most extreme form of alcoholism, making up about 9% of alcoholics. These individuals often start drinking at a very young age and struggle with alcohol throughout their lives. They tend to exhibit the most severe symptoms of alcohol dependence and often suffer from multiple co-occurring mental health disorders.

Key characteristics:

Severe alcohol dependence from a young age

Frequently co-occurs with mental health and other substance use disorders

More likely to have legal or social issues due to drinking

Individuals in this category usually require long-term, intensive treatment that addresses not only the alcohol use but also the underlying mental health conditions that contribute to their drinking behavior.

Source: Moss, H. B., Chen, C. M., & Yi, H. Y. (2007)

6. Binge Drinking Subtype

While not a formal diagnostic category in itself, binge drinking is an increasingly common pattern, particularly among young adults. Binge drinkers do not drink daily but consume large amounts of alcohol over a short period (5 or more drinks in 2 hours for men, 4 or more for women). This type of drinking can be highly dangerous, leading to alcohol poisoning, accidents, and long-term health issues.

Key characteristics:

Episodes of heavy drinking followed by periods of abstinence

Higher risk for alcohol-related accidents and injuries

More common among college students and young professionals

Binge drinking is often underrecognized but can lead to significant long-term consequences for both physical and mental health.

Source: American Psychiatric Association (2013)

7. High-Functioning Alcoholic

Similar to the functional subtype, high-functioning alcoholics manage to maintain successful personal and professional lives despite their alcohol dependence. However, this group is often in denial about their drinking because they do not fit the stereotype of someone struggling with alcoholism.

Key characteristics:

Maintain stable jobs and relationships

Often deny or downplay the severity of their alcohol dependence

May experience fewer consequences initially but can face serious health problems later

High-functioning alcoholics may resist treatment, as they believe their drinking is under control.

Source: Schuckit, M. A. (2009)

8. Late-Onset Alcoholism

The late-onset subtype refers to individuals who develop drinking problems later in life, often as a result of major life changes such as retirement, the death of a spouse, or declining health. While they may not have had issues with alcohol earlier, these changes can lead them to drink more heavily as a coping mechanism.

Key characteristics:

Typically occurs in older adults

Triggered by significant life events or stressors

More common among those facing loneliness or grief

Late-onset alcoholics may require treatment that not only addresses their drinking but also focuses on the life transitions and emotional triggers that led to their alcohol use.

Source: Babor, T. F., Dolinsky, Z. S., & Meyer, R. E. (1994)

Conclusion: A Complex Spectrum of Alcohol Use Disorders

Alcoholism is far more complex than the stereotype of a heavy drinker who can’t control their drinking. The subtypes of alcoholism reveal that alcohol use disorder manifests in many ways, from functional alcoholism to chronic severe dependence. Recognizing these subtypes helps in tailoring treatment approaches and offers a more compassionate understanding of how individuals struggle with alcohol dependence.

Understanding the unique characteristics of each subtype is crucial in addressing the root causes of alcohol use disorder and providing effective, personalized treatment. Whether the problem is rooted in genetic predisposition, emotional triggers, or life circumstances, early intervention and appropriate support can lead to recovery.

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References:

Moss, H. B., Chen, C. M., & Yi, H. Y. (2007). Subtypes of alcohol dependence in a nationally representative sample. Drug and Alcohol Dependence, 91(2-3), 149-158.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC.

Cloninger, C. R., Bohman, M., & Sigvardsson, S. (1981). Inheritance of alcohol abuse: Cross-fostering analysis of adopted men. Archives of General Psychiatry, 38(8), 861-868.

Schuckit, M. A. (2009). Alcohol-use disorders. The Lancet, 373(9662), 492-501.

Babor, T. F., Dolinsky, Z. S., & Meyer, R. E. (1994). Types of Alcoholics: Evidence From Clinical and Experimental Research. New York: Plenum Press.