Classifying medical conditions according to severity and type is a basic requirement for performing triage, and this is also the case for alcohol use disorder (AUD). Alcohol use disorder is a term introduced in the DSM-5, published in 2013. It covers the conditions formerly known as alcohol abuse, alcohol addiction, alcoholism, and alcohol dependence.
In mainstream alcohol rehab practice, the so-called “5 Types of Alcoholics” model is often used under different names to help clinicians with offering more appropriate interventions. This model is based on the 2007 findings of researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This model has since been widely adopted by Boston alcohol rehab centers, as well as most other rehabs throughout the US.
Below are the subtypes according to the 2007 NIAAA survey and some of the things that have to be considered when treating individuals who fall under each. Please note that the survey respondents were composed of individuals throughout America and that these subtypes may not always apply across different cultures.
1.) Young Adult
Young adult “alcoholics” comprised almost a third of the survey’s respondents, with 31.5 percent falling in this category. They consume the most alcohol proportionally of the five subtypes. Given that alcohol use has dropped among young people since 2007, fewer people proportionally may belong to this subtype today.
People in this subgroup do not tend to use other drugs regularly, are less likely to have co-occurring mental health disorders, and are not likely to be married or gainfully employed. They are less likely to drink regularly but are more prone to binge drinking compared to the other groups. Individuals in this group are overwhelmingly male and are less likely to seek help for their problems.
Though any kind of excessive drinking is problematic, this group is often considered less of a risk compared to the others.
2.) Young Antisocial
After Young Adults, the Young Antisocial group is the second most prevalent subtype in the NIAA study, representing a little over a fifth of all surveyed at 21.1 percent of all respondents.
Individuals falling in this subtype are likely to present a significant challenge to treat for several reasons. They are likely to have started drinking in adolescence or childhood and are extremely likely to have developed an AUD by adulthood. This subtype is also the most likely to engage in the use of drugs other than alcohol, which can complicate treatment.
Additionally, this group has an extremely high co-occurrence of psychiatric conditions, particularly antisocial personality disorder for which the subtype is named. Depression, obsessive-compulsive disorder, social phobia, bipolar disorder, and other mental health conditions are also commonly found in this group. As with the Young Adult group, the Young Antisocial subtype is overwhelmingly male, accounting for about 75 percent of all respondents in this type.
Socioeconomic factors may be a predictor of belonging to this group as well. Individuals in this group are more likely to be unemployed or underemployed and also have the lowest income and educational attainment of most of the groups. Fortunately, over a third had sought treatment at the time they were surveyed, making them among the most likely to seek help.
This subtype is the best known among laypersons, as “functional alcoholics” have been a well-known phenomenon and trope for decades. This group is characterized by the apparent lack of negative consequences from their AUD.
Individuals in the Functional subtype tend to skew older, towards middle-age. They are likely to have developed their SUD in adulthood rather than in their adolescence. A little under half (about 40 percent) of the individuals in this group are female, making it the most likely subtype for a female with AUD to belong to.
Individuals in this subgroup are slightly more likely than the general population to have depression and are much less likely than people in other subgroups to have other mental health disorders. They are likely to have relatively high incomes, stable relationships, and are usually respected by family members and colleagues. They are not more likely to use other drugs except for tobacco.
Perhaps because of the lack of negative consequences, individuals in this group are the least likely to seek treatment and are among the most resistant in a rehab setting.
4.) Intermediate Familial
People in this subtype are likely to have developed AUD by being around family members who drink regularly. While they usually start drinking in adolescence or childhood, they tend to develop AUD around their late 20s and early 30s, compared to Young Antisocial individuals who tend to develop AUD in their teens.
Similar to Functional individuals, Intermediate Familial individuals may be able to find gainful employment. In contrast, however, they are less likely to avoid negative consequences from their drinking and are also more likely than the general population to have a wide range of mental health issues. They are also likely to misuse so-called “harder” drugs as well.
At the time of the survey, about 36 percent of the people in this group were female, making it the second most likely subgroup for females after the Functional group. While they are not especially resistant to treatment they are also not more likely than other subtypes to seek it.
5.) Chronic Severe
While this is the smallest subtype, representing just 9 percent of those in the NIAAA survey, Chronic Severe individuals are the most visible and they exhibit issues that are more readily identified by casual observers. However, they tend to drink less overall than the individuals in the Young Adult subtype.
Individuals in this group are overwhelmingly middle-aged and male, at over 80 percent. Most in this group also have co-occurring mental health conditions, particularly PTSD, depression, and bipolar disorder, just to name a few. They are the most likely to experience negative consequences as a result of their drinking. They are also likely to use more drugs than the other groups.
A clear majority (about 70 percent) of individuals in this subgroup sought treatment at the time of the survey, and this may be higher today due to improving attitudes towards AUD treatment. This makes them the most likely to seek treatment and disproportionally represented in AUD rehab programs.
Though it may be time to revisit the “5 Subtypes of Alcoholics” model to update it for the current era, most clinicians involved in treating AUDs may still find some use for it as a part of triage. If you need to learn more about AUD and your options for treating it, our team at Boston Drug Treatment Centers is ready to help. Good luck, and stay sober!