A timely follow-up on the material reviewed from The Cult of Pharmacology (below). Scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH), have categorized five distinct subtypes of alcoholism. Here’s what a couple of the researchers say:
"Our findings should help dispel the popular notion of the 'typical alcoholic,'" notes first author Howard B. Moss, M.D., NIAAA Associate Director for Clinical and Translational Research. "We find that young adults comprise the largest group of alcoholics in this country, and nearly 20 percent of alcoholics are highly functional and well-educated with good incomes. More than half of the alcoholics in the United States have no multigenerational family history of the disease, suggesting that their form of alcoholism was unlikely to have genetic causes."
"Clinicians have long recognized diverse manifestations of alcoholism," adds NIAAA Director Ting-Kai Li, M.D, "and researchers have tried to understand why some alcoholics improve with specific medications and psychotherapies while others do not. The classification system described in this study will have broad application in both clinical and research settings."
IOW, the “one size fits all” story about alcoholism really is one of those “placebo texts” we discussed, making it easier to work with those affected but harder to help those who in reality differ from each other. Here’s the meat of the story:
The researchers identified unique subtypes of alcoholism based on respondents' family history of alcoholism, age of onset of regular drinking and alcohol problems, symptom patterns of alcohol dependence and abuse, and the presence of additional substance abuse and mental disorders:
Young Adult subtype: 31.5 percent of U.S. alcoholics. Young adult drinkers, with relatively low rates of co-occurring substance abuse and other mental disorders, a low rate of family alcoholism, and who rarely seek any kind of help for their drinking.
Young Antisocial subtype: 21 percent of U.S. alcoholics. Tend to be in their mid-twenties, had early onset of regular drinking, and alcohol problems. More than half come from families with alcoholism, and about half have a psychiatric diagnosis of Antisocial Personality Disorder. Many have major depression, bipolar disorder, and anxiety problems. More than 75 percent smoked cigarettes and marijuana, and many also had cocaine and opiate addictions. More than one-third of these alcoholics seek help for their drinking.
Functional subtype: 19.5 percent of U.S. alcoholics. Typically middle-aged, well-educated, with stable jobs and families. About one-third have a multigenerational family history of alcoholism, about one-quarter had major depressive illness sometime in their lives, and nearly 50 percent were smokers.
Intermediate Familial subtype: 19 percent of U.S. alcoholics. Middle-aged, with about 50 percent from families with multigenerational alcoholism. Almost half have had clinical depression, and 20 percent have had bipolar disorder. Most of these individuals smoked cigarettes, and nearly one in five had problems with cocaine and marijuana use. Only 25 percent ever sought treatment for their problem drinking.
Chronic Severe subtype: 9 percent of U.S. alcoholics. Comprised mostly of middle-aged individuals who had early onset of drinking and alcohol problems, with high rates of Antisocial Personality Disorder and criminality. Almost 80 percent come from families with multigenerational alcoholism. They have the highest rates of other psychiatric disorders including depression, bipolar disorder, and anxiety disorders as well as high rates of smoking, and marijuana, cocaine, and opiate dependence. Two-thirds of these alcoholics seek help for their drinking problems, making them the most prevalent type of alcoholic in treatment.
I’ll resist the urge to say gee, all of these folks must have used marijuana as their starter drug, but note that cigarettes seem to be the most common co-occurring drug here. I see two other things of importance in this. One, this research does show that drugs affect different people differently and it’s only a minority dysfunctional to a point possibly warranting social intervention. Two, this kind of differentiation can hopefully be extended to other users and substances to start giving us a better picture of how many people are similarly badly impacted rather than relying on anecdotes that coincidentally further the interests of the people telling the story. Treatments and approaches can be better tailored for greater effectiveness in ways that are impossible when we treat everyone the same. It will be interesting to see if this research swirls into the usual vacuum or whether it gets legs and has impact.
[Yeah, I realize I totally left out any of the TECHNOCORRECTIONS implications of all this and the whole pharmacogenomics concept, matching drug treatments to particular genetic structures of the specific individuals. I’ll leave it to you to connect the dots in comments if you like.]