The Different Types of Alcoholics

Explore alcoholism types and how to support those with alcohol use disorder.

July 2, 2024

Understanding Alcohol Use Disorder

Alcohol Use Disorder (AUD) is a condition characterized by a maladaptive pattern of excessive drinking that leads to significant problems in a person's life. It is a complex genetic disease with variations in a large number of genes affecting the risk.

Definition and Characteristics

Alcohol Use Disorder is a chronic condition that involves an inability to control or stop drinking despite the negative consequences it may cause. It is diagnosed based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Some of the common characteristics of AUD include:

Craving or a strong desire to drink alcohol
Difficulty in controlling the amount of alcohol consumed
Continued alcohol use despite its persistent negative effects on physical health, mental well-being, or social relationships
Development of tolerance, requiring increased amounts of alcohol to achieve the desired effect
Experience of withdrawal symptoms when attempting to quit or cut down on drinking

The severity of AUD can range from mild to severe, depending on the number of symptoms present. It is important to note that AUD is a treatable condition, and seeking professional help is crucial for recovery.

Risk Factors and Genetic Influences

Genetics play a significant role in the development of Alcohol Use Disorder. Research shows that genes contribute to about half of the risk for AUD, while environmental factors and gene-environment interactions account for the remainder [2].

Multiple genes are involved, with some increasing the risk and others decreasing it. For example, individuals of Asian descent may carry a gene variant that affects alcohol metabolism, leading to symptoms like flushing, nausea, and rapid heartbeat, which can act as a deterrent against developing AUD.

Scientists are actively studying how genes may impact the effectiveness of treatments for AUD. For instance, specific gene variations have been found to influence the response to certain medications, such as naltrexone, which can help reduce drinking in some patients with AUD. Understanding the role of genes in treatment outcomes can assist healthcare professionals in prescribing the most effective treatment for each individual.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has been funding research to identify specific genes that influence alcohol use disorder for several decades. The Collaborative Studies on Genetics of Alcoholism (COGA), initiated in 1989, aims to enhance knowledge about the genetic influences on AUD. NIAAA also supports researchers in studying gene-environment interactions to further improve treatment and prevention efforts.

Understanding the genetic factors and risk associated with Alcohol Use Disorder can contribute to the development of more effective treatments and prevention strategies. It underscores the importance of a holistic approach that considers both genetic and environmental influences in addressing AUD.

Types of Alcoholics

Alcohol use disorder (AUD) is a complex condition that can manifest in various ways. Understanding the different types of alcoholics can help shed light on the diverse profiles and characteristics of individuals struggling with AUD. Here are five common subtypes:

Functional Alcoholic Profile

Functional alcoholics, as described by the National Institutes of Health, are typically "middle-aged, well-educated, with stable jobs and families". While not a formal medical diagnosis, this term is used colloquially to describe individuals who are dependent upon alcohol but can still function in society.

Despite appearing physically and mentally healthy, functional alcoholics often experience uncontrollable cravings, unsuccessful attempts at quitting, and obsessive thoughts about their next drink [3]. They may consume as much alcohol as someone with an alcohol use disorder but may not exhibit outward symptoms of intoxication due to developed tolerance.

It's important to note that functional alcoholics may resist seeking help, even when they recognize they have a drinking problem. This resistance can be attributed to the fear of experiencing severe withdrawal symptoms, which may lead them to continue drinking to keep the symptoms at bay.

Young Adult Subtype

The young adult subtype of alcoholics typically includes individuals who develop AUD during their late teens or early twenties. This group often experiences high levels of social and interpersonal problems due to their alcohol consumption. They may engage in risky behaviors, struggle with impulse control, and exhibit patterns of alcohol-related aggression [4].

Functional Subtype

The functional subtype of alcoholics is characterized by individuals who have relatively stable relationships and successful careers, despite their problematic alcohol use. They often have a later onset of AUD and may not experience severe physical or psychological impairments. However, they still meet the criteria for an alcohol use disorder and may face long-term health consequences if left untreated [4].

Young Antisocial Subtype

The young antisocial subtype is characterized by individuals who exhibit both AUD and antisocial personality disorder. They tend to start drinking at an early age, engage in impulsive and aggressive behavior, and have a higher prevalence of legal and substance abuse problems. This subtype is more common in males and is associated with a higher risk of developing other substance use disorders.

Chronic Severe Subtype

The chronic severe subtype represents individuals with a long history of severe alcohol dependence and multiple failed attempts at quitting or reducing their alcohol consumption. This subtype often experiences significant physical and psychological impairments due to their alcohol use. They may require intensive treatment and support to address their complex needs and achieve long-term recovery.

Understanding these different subtypes can provide valuable insights into the diverse nature of alcohol use disorder and guide targeted treatment approaches. It's important to remember that each individual's journey with AUD is unique, and a personalized approach to treatment is essential for achieving successful outcomes.

Treatment Approaches for Alcohol Use Disorder

When it comes to addressing Alcohol Use Disorder (AUD), healthcare professionals provide different treatment approaches to help individuals overcome their struggles with alcohol. These approaches include behavioral treatments, medications, and various levels of care.

Behavioral Treatments

Behavioral treatments are an essential component of AUD treatment. They aim to help patients set goals, identify triggers that could prompt drinking, develop skills to stop or reduce drinking, manage emotions and stress, and build relationships that support treatment goals. Therapists specializing in addiction may offer one-on-one, couples, family, or group sessions to address the unique needs of each individual [5].

The following are some evidence-backed behavioral treatments commonly used for AUD:

Cognitive-Behavioral Therapy (CBT): Focuses on identifying and changing unhealthy patterns of thinking and behavior related to alcohol use.
Motivational Enhancement Therapy (MET): Aims to increase motivation and commitment to change through a person-centered approach.
Contingency Management: Utilizes positive reinforcement and rewards to encourage abstinence or reduced alcohol consumption.
Family Behavior Therapy: Involves the participation of family members to improve communication and support sobriety.

These behavioral treatments can be delivered in various formats, including individual therapy, group therapy, or a combination of both. The choice of treatment approach depends on the individual's needs and preferences, as well as the recommendations of the healthcare professionals involved in their care.

Medications for AUD

In addition to behavioral treatments, medications have been approved by the FDA to help prevent a return to heavy drinking for individuals with AUD. Three medications commonly prescribed are:

Acamprosate: Helps to reduce alcohol cravings and withdrawal symptoms.
Naltrexone: Blocks the effects of alcohol and reduces the desire to drink.
Disulfiram: Creates unpleasant physical reactions when alcohol is consumed, acting as a deterrent to drinking.

These medications can be effective when used as part of a comprehensive treatment plan. However, it's important to note that these medications are often underused, with a low prescription rate for individuals with AUD.

Levels of Care in Alcohol Treatment

Evidence-based specialty treatment for AUD is provided at different levels of care or intensity, which form a continuum of care. The levels of care, as defined by the American Society of Addiction Medicine, include:

Outpatient Treatment: Most AUD treatment is provided in outpatient settings, allowing individuals to receive therapy and support while living at home and continuing their daily activities.
Intensive Outpatient Programs (IOP): These programs offer more structured treatment with increased therapy sessions and support, usually with a schedule of several hours per day, several days per week.
Partial Hospitalization Programs (PHP): Individuals receive treatment in a hospital-like setting during the day but return home in the evenings.
Inpatient or Residential Treatment: This level of care involves round-the-clock care in a residential facility, providing a highly structured environment for individuals with more severe AUD or those who require a higher level of support.

The choice of the appropriate level of care depends on the individual's needs, the severity of their AUD, and the recommendations of healthcare professionals.

By combining behavioral treatments, medications, and the appropriate level of care, individuals with AUD can receive comprehensive and personalized treatment to support their journey toward recovery. It's important for individuals seeking treatment to consult with healthcare professionals who can guide them in selecting the most suitable treatment approach for their specific needs and circumstances.

Evidence-Based Treatment Options

When seeking treatment for Alcohol Use Disorder (AUD), there are several evidence-based options available that have been shown to be effective in helping individuals on their recovery journey. These treatment options include behavioral health treatment, medications for AUD, and mutual support groups.

Behavioral Health Treatment

Behavioral health treatment, also known as behavioral therapy, is an important component of AUD treatment. This type of treatment focuses on changing unhealthy behaviors and developing coping strategies to prevent relapse. Behavioral therapy can be delivered in various formats, including individual counseling, group therapy, and family therapy.

The goal of behavioral health treatment is to help individuals understand the factors that contribute to their alcohol use and develop skills to manage cravings, cope with stress, and make healthier choices. It may involve techniques such as cognitive-behavioral therapy (CBT), motivational interviewing, and contingency management.

Medications for AUD

Medications can be an effective tool in the treatment of AUD. Three medications have been approved by the FDA for this purpose: acamprosate, naltrexone, and disulfiram. These medications work in different ways to support recovery.

Acamprosate helps individuals maintain abstinence by reducing withdrawal symptoms and alcohol cravings. Naltrexone blocks the effects of alcohol and reduces the desire to drink. Disulfiram creates an unpleasant reaction when alcohol is consumed, acting as a deterrent to drinking.

However, despite the proven effectiveness of these medications, they are underutilized. According to a 2021 analysis, only 1.6% of adults with past-year AUD were prescribed these medications [5].

Mutual Support Groups

Mutual support groups play a crucial role in the recovery journey for individuals with AUD. These groups provide a supportive and nonjudgmental environment where individuals can share their experiences, receive encouragement, and learn from others who have gone through similar struggles.

Alcoholics Anonymous (AA) is one of the most well-known mutual support groups and follows a 12-step program. However, there are also secular alternatives like SMART Recovery, LifeRing, Women for Sobriety, Secular Organizations for Sobriety, and Secular AA. These mutual help groups can be as effective as 12-step programs for individuals aiming for abstinence [5].

Participating in mutual support groups can provide individuals with a sense of community, accountability, and ongoing support in their recovery journey. It is important to find a group that aligns with one's personal beliefs and preferences.

Levels of Care in Alcohol Treatment

Evidence-based specialty treatment for AUD is offered at different levels of care, depending on the individual's needs and the severity of their condition. The American Society of Addiction Medicine defines four basic levels of care or intensity, forming a continuum of care:

Outpatient Treatment: Most AUD treatment is provided in outpatient settings, allowing individuals to receive therapy and support while maintaining their daily routines.
Intensive Outpatient Programs (IOP): IOPs provide more structured and intensive treatment than standard outpatient programs, typically involving multiple sessions per week.
Partial Hospitalization Programs (PHP): PHPs offer a higher level of care, with individuals attending treatment sessions during the day and returning home in the evenings.
Inpatient Treatment: Inpatient treatment, also known as residential treatment, provides individuals with 24-hour care in a structured and supportive environment. This level of care is typically reserved for those with severe AUD or co-occurring mental health conditions.

The appropriate level of care is determined based on a comprehensive assessment of the individual's needs, and individuals may step up or down in treatment intensity as needed.

By combining behavioral health treatment, medications for AUD, and participation in mutual support groups, individuals can access a comprehensive and evidence-based approach to their recovery from AUD. These treatment options can be tailored to meet the unique needs of each individual, increasing the chances of successful and sustained recovery.

Impact of Childhood Trauma on Alcohol Dependence

Childhood trauma can have a profound impact on an individual's life, including their vulnerability to alcohol dependence. Understanding the prevalence of childhood trauma and its effects on alcohol dependence is essential in providing appropriate support and treatment. In this section, we will explore the prevalence of childhood trauma, the effects on alcohol dependence, and the relationship between emotional abuse and alcohol dependence severity.

Prevalence of Childhood Trauma

Research has shown that childhood trauma, including emotional abuse, sexual abuse, physical abuse, emotional neglect, and physical neglect, is significantly more prevalent among individuals seeking treatment for alcohol dependence compared to healthy controls.

The odds ratios for childhood trauma exposure range from 3.5 for physical abuse to 11.5 for emotional abuse. The severity of childhood trauma is also higher in individuals with alcohol dependence, with effect sizes ranging from medium to large.

Among the different types of childhood trauma, emotional abuse and neglect are found to be the most frequent types among individuals with alcohol dependence [6]. These findings highlight the need for targeted interventions and support for individuals who have experienced emotional abuse and neglect during their formative years.

Effects of Childhood Trauma on Alcohol Dependence

Childhood trauma, particularly emotional and physical abuse, has been identified as a significant risk factor for the development of severe alcohol dependence. Individuals with a history of childhood emotional abuse may represent a distinct sub-group of alcoholics, requiring tailored treatment approaches that address the long-term effects of childhood abuse and meet their psychiatric and psychosocial needs.

Emotional Abuse and Alcohol Dependence Severity

Emotional abuse has emerged as a key predictor of alcohol dependence severity, even when controlling for other forms of abuse and neglect [6]. It exerts both direct and indirect effects through the mediating role of the impulsivity subfacet of neuroticism. The severity of emotional abuse experienced during childhood is associated with higher levels of impulsivity, which in turn contributes to the severity of alcohol dependence.

Recognizing the impact of emotional abuse on alcohol dependence severity is crucial for designing effective treatment interventions. Tailored approaches that address the unique needs of individuals with a history of childhood emotional abuse can provide them with the necessary support and resources to overcome alcohol dependence.

Understanding the relationship between childhood trauma and alcohol dependence can inform treatment strategies and help healthcare professionals develop targeted interventions for individuals with a history of childhood abuse. By addressing the long-term effects of childhood trauma and providing appropriate support, we can enhance the effectiveness of treatment and improve outcomes for those struggling with alcohol dependence.