There appear to be five distinct subtypes of alcohol dependence and understanding which profile a patient fits may help improve treatment planning and long-term care, according to an article published online June 25 by Drug and Alcohol Dependence. The analysis was conducted by researchers at the National Institute on Alcohol Abuse and Alcoholism (National Institutes of Health) based on U.S. national data

"Our findings should help dispel the popular notion of the ‘typical alcoholic,’” noted lead author Howard B. Moss, MD, 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,” added 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.”

Previous efforts to identify alcoholism subtypes focused primarily on individuals who were hospitalized or otherwise receiving treatment for their alcoholism. However, recent reports from NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative epidemiological study of alcohol, drug, and mental disorders in the United States, suggest that only about one-fourth of individuals with alcoholism have ever received treatment. Thus, a substantial proportion of people with alcoholism were not represented in the samples previously used to define subtypes of this disease.

In the current study, Dr. Moss and colleagues applied advanced statistical methods to data from the NESARC. Their analyses focused on the 1,484 NESARC survey respondents who met diagnostic criteria for alcohol dependence and included individuals in treatment as well as those not seeking treatment. 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:

The most common subtype, the young adult group, accounted for 31.5 percent. These people, who had relatively low rates of co-occurring substance abuse and other mental disorders, along with a low rate of family alcoholism, rarely sought any kind of help for their drinking.

The most common subtype, the young adult group, accounted for 31.5 percent. These people, who had relatively low rates of co-occurring substance abuse and other mental disorders, along with a low rate of family alcoholism, rarely sought any kind of help for their drinking.

The young antisocial subtype accounted for 21 percent of U.S. alcoholics. These people tended to be in their mid-twenties and had an early onset of regular drinking and alcohol-related problems. More than half came from families with alcoholism, and about half had a psychiatric diagnosis of Antisocial Personality Disorder. Many had major depression, bipolar disorder, or anxiety problems. More than 75 percent smoked cigarettes and marijuana, and many also had cocaine and opiate addictions. More than one third of these people had sought help for their drinking.

Slightly less than one fifth (19.5 percent) of alcoholics fit the functional subtype. These people were typically middle-aged, well-educated, and had stable jobs and families. About one third had a multigenerational family history of alcoholism, about one quarter had major depressive illness at some point in their lives, and nearly 50 percent were smokers.

The intermediate familial subtype accounted for 19 percent of U.S. alcoholics. These people were also middle-aged, and about 50 percent came from families with multigenerational alcoholism. Almost half had clinical depression at some point in their lives, and 20 percent had bipolar disorder. Most of these individuals smoked cigarettes, and nearly one in five had problems with cocaine and marijuana use. Only 25 percent had ever sought treatment for their problem drinking.

The chronic severe subtype fit 9 percent. This group was comprised mostly of middle-aged individuals who had early-onset drinking and alcohol-related problems; there were high rates of Antisocial Personality Disorder and criminality. Almost 80 percent came from families with multigenerational alcoholism. They had 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 this group sought help for their drinking problems, making them the most prevalent type of alcoholic in treatment.

The authors also reported that co-occurring psychiatric and other substance abuse problems are associated with severity of alcoholism and entering into treatment. Attending Alcoholics Anonymous and other 12-step programs is the most common form of help-seeking for drinking problems, but help-seeking remains relatively rare.