While approximately 15 million American adults suffer from alcohol use disorder, fewer than 1 in 10 typically seek treatment for addiction. Five types of alcoholics exist, and the type can influence whether or not people choose to seek treatment for their addiction. It also can determine whether a certain type of treatment will be more effective than another.
No two alcoholics are exactly the same, but many people with alcoholism share common characteristics. By analyzing a large national sample of people who have an alcohol use disorder, federal researchers have identified five common subtypes of alcoholics:
Experts in the field of addiction say these categories are more than just labels — they can also be useful tools in treating alcoholism. Because there’s no one-size-fits-all solution when it comes to treating an alcohol addiction, understanding a person’s alcoholic subtype can help patients and physicians identify the most effective form of treatment.
Nearly 32 percent of alcoholics fall into the young adult category, making it the most prevalent subtype in the U.S. The typical young adult alcoholic is about 25 and started drinking at age 19 or 20. Men outnumber women 2.5 times to 1 in this category, and they tend to be single. Only 54 percent work full time, and 36.5 percent are in school.
On average, young adult alcoholics drink about 143 days each year.
Few young adult alcoholics use other drugs or have legal problems. They also have a low incidence of family history of alcoholism. On average, they drink about 143 days each year, and they typically consume five or more drinks at a time. Few seek help for their drinking, but when they do, they gravitate toward 12-step groups as opposed to private treatment.
Young antisocial alcoholics are also typically their mid-20s. But they started drinking much earlier than young adult alcoholics — usually by the age of 15 or 16. Researchers found that 21.1 percent of alcoholics fall into this category. Their alcoholism usually manifests by the time they are 18 or 19, and more than half come from families with alcoholism.
More than 50 percent of young antisocial alcoholics have a psychiatric diagnosis of antisocial personality disorder, a mental condition characterized by antagonism and a callous disregard of others and the law. Many also suffer from other mental illnesses, including major depression, bipolar disorder, social phobias and obsessive-compulsive personality disorder.
Most are smokers, and they’re more likely than other subtypes to use other drugs such as marijuana, cocaine, opioids and amphetamines. More than three-quarters of young antisocial alcoholics are male, and about 15 percent are married. They drink approximately 201 days out of each year and usually consume five or more drinks per sitting.
While nearly 35 percent of young antisocial alcoholics have sought help for their drinking at some point, they have the “worst prognosis of any of the subtypes,” according to Dr. Howard Moss, the former associate director for clinical and translational research at the National Institute on Alcohol Abuse and Alcoholism.
To achieve sobriety, he says, treatment must focus on “complete abstinence and elimination of other forms of substance abuse and also mainstreaming their behaviors” so they function better in society.
Alcohol made her lose her job and friendships. Read about Kelly’s journey and how sobriety helped her find happiness.Read Her Story
Nearly 20 percent of alcoholics are functional alcoholics. They tend to be well-educated, high-income earners with a relatively stable home life. And because they don’t look or act like the stereotypical alcoholic, they’re often in denial about their drinking problem.
That’s exactly what happened to ABC news anchor Elizabeth Vargas, a functional alcoholic who sought treatment for an alcohol addiction in 2014 after years of trying to hide her drinking.
“Denial is huge for any alcoholic, especially for a functioning alcoholic, because I, you know, I’m not living under a bridge. I haven’t been arrested,” Vargas told USA Today.
While most high-functioning alcoholics begin drinking at about 18, they don’t develop an addiction to alcohol until their late 30s. Approximately one-third have a family history of alcoholism, and about one-quarter have been diagnosed with major depression.
“Denial is huge for any alcoholic, especially for a functioning alcoholic.”
Functional alcoholics are more likely to smoke but usually aren’t addicted to other substances. They typically drink every other day, consuming five or more drinks on average, and they often surround themselves with others who drink heavily. They may also make excuses for their drinking.
Only 17 percent have ever sought treatment for their addiction. When they do seek treatment, they’re more likely to attend a 12-step group or seek treatment from private health care professionals.
Because their alcohol addiction has fewer obvious negative consequences, an important aspect of treating functional alcoholics is getting them to recognize that they have a problem. In addition, Moss said it is crucial for functional alcoholics to focus on abstinence or return to less dangerous drinking levels.
Nearly 19 percent of alcoholics in the U.S. fall into the intermediate familial category. Most are middle-aged, began drinking at about 17 and were addicted to alcohol by their early 30s.
Nearly 50 percent of intermediate familial alcoholics have a family history of alcoholism.
Nearly 50 percent have a family history of alcoholism, and co-occurring mental illness is prevalent. Approximately half suffer from clinical depression, and about 1 in 5 has been diagnosed with bipolar disorder and obsessive-compulsive disorder. Intermediate familial alcoholics are more likely to be male and have a job. Most are smokers, and 20 to 25 percent have also used cocaine and marijuana.
More than a quarter have sought help for their drinking at some point through self-help groups, treatment programs, detoxification programs and health care providers.
Nine percent of alcoholics fall into the chronic severe category. Most are middle-aged and began drinking by the time they were 16. Many have been diagnosed with antisocial personality disorder and other mental illnesses, including major depression, bipolar disorder, anxiety disorders, social phobias and panic disorder. The majority smoke, and many use other drugs, including marijuana, cocaine and opioids.
They have the highest divorce rate — 25.1 percent — of all the alcoholic types. Only 9 percent have gone to college, and only 43 percent are employed full time. They drink more heavily than any other type of alcoholic, consuming alcohol 248 days of the year on average and drinking five or more drinks 69 percent of the time.
While two-thirds have sought treatment for their addiction, it’s important that any treatment program address their co-occurring disorders and include therapies focused on preventing relapse.