There is a stereotype in America of a “typical alcoholic.” However, a study from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute of Health (NIH), and the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) put that notion to rest. These organizations conducted a national, clinical study derived from various studies on alcoholics. The study found that there are five subtypes of alcoholics:
• Young Adult Subtype
• Functional Subtype
• Intermediate Familial Subtype
• Young Antisocial Subtype
• Chronic Severe Subtype
These subtypes are categories based off the age of the individual, the age they started drinking, the age they developed an alcohol dependence, their family history of alcoholism, the presence or absence of co-occurring mental health conditions, and the presence of absence of other substance abuse disorders. They are not meant as a diagnostic to determine if someone is suffering from alcoholism. Rather, they are meant to further the study of alcoholism and guide future research and prevention efforts.
Different types of alcoholics will suffer for different reasons. Some groups may not even realize that their drinking is a problem. Rather, it is just a part of who they are. However, no matter your age, status, or family, alcoholism can create long-term problems that damage your health and relationships, no matter the subtype.
Young Adult Subtype
It is determined that roughly 31.5% of alcoholics fall into the category of young adults, which is the largest single group. This group tends to begin drinking at an early age (around 19) and also develops an alcohol dependence early (around 24). This group has comparatively low rates of co-occurring mental health conditions, and moderate rates of other substance abuse disorders and family members with alcoholism.
The young adult subtype is less likely to have a full-time job, but is more likely to be in college than other groups. This group is also unlikely to ever have been married. This subtype drinks less frequently than others, but is very likely to engage in binge drinking when they do. Members of this group are 2.5 times more likely to be male than female. While it is very unlikely that a member of this group will seek out treatment, they are most likely to seek out a 12-Step program if they do.
The Functional subtype is what you might think of when you hear “functional alcoholics.” Making up 19.5% of alcoholics, this is the group that are holding down jobs and relationships. This group tends to be middle aged (around 41). Members of this group generally start drinking later (around 18) and develop an alcohol dependence later (around 37). This group suffers from moderate rates of depression, but lower rates of most other co-occurring disorders. Many members of this group smoke cigarettes, but few have other substance use disorders. Around 60% of this group are male.
Of all subtypes, the functional subtype is the least likely to have legal problems, and they are the least likely to report problems due to their drinking. They have the highest education levels and income of all types of alcoholics. Half of this group are married. These are people that may seem to have their lives together, the ones that others look up to. However, while they are “functional” in a sense, they are still suffering from addiction. Less than 20% of this subgroup has sought help, and most do so from a 12-Step program or a private health care professional.
Intermediate Familial Subtype
The intermediate familial subtype accounts for 18.8% of alcoholics. This group tends to start drinking younger (around 17) and also develops an alcohol dependence earlier (around 32). This subgroup is very likely to have had immediate family members with alcoholism. They also have high probability of suffering from anti-social personality disorder, depression, generalized anxiety disorder, and bipolar disorder. This group also suffers from high rates of cigarette, marijuana, and cocaine addiction.
The intermediate familial subtype is 64% male. This group has a higher education level than most, but not as high as the functional subtype. More members of this group have full-time jobs than any other, but their income level tends to be lower than the functional subtype. While this group is not especially likely to seek treatment, those that do tend to attend self-help groups, specialty treatment programs, detoxification programs, and private health care providers.
Young Antisocial Subtype
21.1% of alcoholics fall into the young antisocial subtype. This group tends to start drinking at the youngest age (around 15) and also develops an alcohol dependence at the earliest age (around 18). More than 50% of this group have traits of anti-social personality disorder. They also have high rates of depression, bipolar disorder, social phobia, and obsessive compulsive disorder. This group also has the highest rates of other substance abuse disorders, including addiction to cigarettes, marijuana, meth, cocaine, and opioids. More than 3/4 of the members of this group are male.
This group has the lowest levels of education, employment and income of any group. This group also drinks more at one time and more overall than other group, although they drink slightly less frequently than the . On the other hand, this group is more likely to seek help than almost any other, with 35% having sought out some form of assistance in overcoming alcoholism. This group has the highest rate of seeking treatment from a private health care provider, but also often choose self-help groups, specialty treatment programs, and detox programs.
Chronic Severe Subtype
The chronic severe subtype makes up the smallest percentage of alcoholics, with only 9.2%. This group tends to start drinking at a young age (around 15) but typically develops an alcohol dependence at an intermediate age (around 29). 77% of this group have close family members with alcoholism, the highest percentage of any subtype. 47% of the members of this group exhibit anti-social personality disorder, the second highest rate of any subtype. This subtype is the most likely of any to experience major depression, dysthymia, bipolar disorder, generalized anxiety disorder, social phobia, and panic disorder. This group also is very likely to experience addiction to cigarettes, marijuana, cocaine, and opioids.
More than 80% of this group experiences acute alcohol withdrawal and persistent efforts to cut down, and more than 90% experience drinking despite the problems it causes them and drinking larger amounts and for longer than intended. This group also tends to spend significant amount of time recovering from alcohol and many experience reduced activities due to drinking. This group also sees the highest rate of emergency room visits due to drinking.
This group has the highest rates of divorce and separation. This group has one of the lowest education levels of any subtype, and also has the lowest employment rate. This group drinks more frequently than any other, although their total alcohol intake is less than the young antisocial subtype. 66% of this subtype have sought help for their alcoholism at some point, making them by far the most likely to have done so. They often seek help at self-help groups, rehabilitation programs, and detox programs. They have the highest rate of seeking treatment at an inpatient program, and also seek out help from private physicians, psychiatrists, and social workers at high rates.