What are the Five Types of Alcoholism?

Alcohol misuse is a major public health issue in the United States. In 2019, 25.8% of American adults reported engaging in binge drinking within the past month, and 6.3% reported engaging in heavy alcohol use within the same time frame.1 There is a vast spectrum of alcohol misuse, ranging from occasional binge drinking to those considered a functioning alcoholic, to chronic and severe alcoholism. Learn more about the five types of alcoholism.1,2

In this article:

The Five Types of Alcoholism

In 2007, scientists at the National Institute of Alcohol Abuse and Alcoholism (NIAAA) conducted a national survey on alcohol dependence (alcoholism). Their research debunked the idea of a typical alcoholic, revealing diverse manifestations of alcoholism. They identified five unique subtypes of alcoholism based on the following:2

  • Age of onset of alcohol problems
  • Family history of alcoholism
  • Symptom patterns of alcohol misuse and dependence
  • Presence of co-occurring substance use and mental health disorders

If you are struggling with alcohol misuse despite negative personal, professional, and health consequences, you may fit into one of the five types of alcoholism or alcoholics.

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1. Young Adult Subtype

The first subtype of alcoholism is the young adult subtype, also called the young alcoholic. This type of alcoholism is the most common, with 31.5% of American alcoholics falling into this category.2 These are the young adult drinkers (average age 24.5) with relatively low rates of co-occurring mental health or substance use disorders, low rates of family alcoholism, and little to no history of legal problems.

Around 36% of young alcoholics are still in school, suggesting that they may be an unrecognized part of the college drinking problem. Young alcoholics rarely seek treatment for their drinking. When they do seek help, it is usually through a 12-step program or support group rather than counseling or rehabilitation.3

2. Young Antisocial Subtype

Around 21% of American alcoholics fall into the young antisocial subtype. These people are young, usually in their mid-twenties, and have an early onset of problematic alcohol use and regular alcohol consumption. Nearly 50% of them have a co-occurring diagnosis of antisocial personality disorder, and more than half of them have a strong family history of alcoholism.2

Other co-occurring mental health diagnoses in this subtype include bipolar disorder, major depression, and anxiety. One-third of young antisocial alcoholics will seek professional help for their drinking.2 This sub-group has the highest severity of alcohol consumption in terms of both the rate of binge drinking and the quantity of alcohol consumed. They are also the least educated and are typically on the lower end of the socioeconomic spectrum.3

3. Functioning Alcoholic Subtype

The functional subtype accounts for about 19.5% of U.S. alcoholics. Functioning alcoholics are usually middle-aged, well-educated, and have stable jobs and families. Around one-third have a multigenerational family history of alcoholism, and 25% have a major depressive episode at least one time in their lives.2

Many functioning alcoholics have a later initiation to drinking and onset of alcohol dependence. They have lower rates of co-occurring mental health and substance use disorders. They also have the highest family income of all the subtypes and the least number of legal problems. While functional alcoholics have the highest level of functioning of all the subgroups, they are still vulnerable to the biomedical health risks of chronic alcohol use.3

4. Intermediate Familial Subtype

Approximately 19% of American alcoholics fall into the intermediate familial subtype. These are middle-aged people with an earlier onset of alcohol dependence, half of whom have a multigenerational family history of alcoholism.2,3

Nearly half of this group also has a co-occurring diagnosis of clinical depression, and 20% have bipolar disorder. While many meet the criteria for co-occurring substance use disorders, most people in this subtype have lower rates of binge drinking and lower overall alcohol consumption than other subgroups. Only around 25% of alcoholics in this subtype will seek professional treatment.2,3

5. Chronic Severe Subtype

The chronic severe subtype accounts for about 9% of U.S. alcoholics. This group is mostly comprised of middle-aged people with an early onset of drinking and problematic alcohol use. Nearly 80% have a multigenerational family history of alcoholism. They also have the highest rates of co-occurring mental health disorders, including antisocial personality disorder, depression, anxiety, bipolar disorder, as well as the highest rates of co-occurring substance use disorders, such as marijuana, cocaine, and opiate dependence.2

This group drinks with the highest frequency and the highest binge rate. They tend to have the lowest socioeconomic status. They also report the most alcohol-related psychological and social problems.3 The chronic severe subtype is the most likely to seek treatment, with two-thirds eventually seeking help for their drinking.2

Tailoring Treatment f0r Different Types of Alcoholism

Classifying the five types of alcoholism was an important step for addiction research and treatment because it acknowledges the variability in addictive behaviors, symptoms, and consequences. Because not every case of alcoholism is the same, tailoring addiction treatment to the individual person may help improve rates of success.

For example, more than half of alcoholics have no multigenerational history of alcoholism, suggesting that there isn’t likely a genetic component to their condition.2 In these situations, behavioral approaches, such as mindfulness interventions or cognitive behavioral therapy (CBT), may be most appropriate.

On the other hand, alcoholics with a strong family history of alcoholism may benefit from family therapy to get to the root cause of drinking and to improve relationships. Medications such as naltrexone, acamprosate, and disulfiram may also be effective treatment options.4

Person-centered treatment helps provide treatment modalities that are most suited to the individual. For example, those with co-occurring mental health disorders typically require integrated substance use and mental health treatment—known as dual diagnosis treatment—to fully recover.

Furthermore, people categorized among the chronic severe subtype may benefit most from inpatient treatment. Residing in the facility full time, in an alcohol-free environment provides an opportunity to fully focus on recovery without the stressors and triggers of the outside world.4

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Removing Barriers to Treatment

Classifying alcoholism into subtypes can also help identify and remove barriers to professional assessment and treatment. For example, those in the chronic and severe subgroup tend to have the lowest socioeconomic status. This means that while they may benefit most from inpatient treatment, they may not be able to financially afford the cost. One way to help remove that barrier to treatment would be to support these people in seeking affordable insurance options, treatment grants, scholarships, or loans.

Research has indicated that young alcoholics are least likely to seek treatment and when they do, it tends to be a support group like Alcoholics Anonymous (AA).2 Knowing this treatment barrier, treatment professionals can target people in this subgroup by advertising support group options and providing detailed information about other treatment modalities during the support group.

Alcohol Use Disorder: A Clinical Diagnosis

While the terms “alcoholic” and “alcoholism” are the language of the original research conducted by the National Institute on Alcohol Abuse and Alcoholism, these terms are not considered clinical terms today. The clinical term is alcohol use disorder (AUD). AUD is defined as a medical condition characterized by an inability to quit or reduce alcohol consumption despite negative consequences. Alcohol use disorder encompasses the entire spectrum of alcohol misuse, including alcohol dependence and the commonly used term, alcoholism.4 Around 18 million American adults have a clinical diagnosis of AUD.5

Alcohol use disorder is considered a brain disorder, affecting the functioning and structure of the brain, and symptoms can range from mild to moderate to severe.

When being assessed for alcohol use disorder, you will be asked a series of questions about your alcohol use.
If you answer yes to more than two questions, you are considered to have a mild case of AUD. If you answer yes to more than four questions, you are considered to have a moderate case of AUD. Finally, those that answer yes to six or more questions are considered to have a severe case of alcohol use disorder.4

If you or someone you love is struggling to control alcohol use despite negative consequences, you may consider seeking professional assessment or treatment. For information about diagnostic and treatment options, call “800-839-1686Who Answers?” to speak to an addiction treatment specialist.

Resources

  1. National Institute on Alcohol Abuse and Alcoholism. (June 2021). Alcohol Facts and Statistics.
  2. National Institute on Alcohol Abuse and Alcoholism. (June 2007). Researchers Identify Alcoholism Subtypes.
  3. Moss, H., Chen, C., & Yi, H. (December 2007). Subtypes of Alcohol Dependence in a Nationally Representative Sample. Drug Alcohol Dependence, 91(2-3): 149-158.
  4. National Institute on Alcohol Abuse and Alcoholism. (April 2021). Understanding Alcohol Use Disorder.
  5. U.S. National Library of Medicine. Alcohol Use Disorder (AUD).

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