|Researchers Identify Alcoholism Subtypes
Analyses of a national sample of individuals with alcohol dependence
(alcoholism) reveal five distinct subtypes of the disease, according
to a new study by scientists at the National Institute on Alcohol
Abuse and Alcoholism (NIAAA), part of the National Institutes of
"Our findings should help dispel the popular notion of the ‘typical
alcoholic,’” notes first author Howard B. Moss, M.D., 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
“Clinicians have long recognized diverse manifestations of alcoholism,” adds
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.” A report of the study is now available
online in the journal Drug and Alcohol Dependence.
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
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:
Young Adult subtype: 31.5 percent of U.S. alcoholics.
Young adult drinkers, with relatively low rates of co-occurring
substance abuse and other mental disorders, a low rate of family
alcoholism, and who rarely seek any kind of help for their drinking.
Young Antisocial subtype: 21 percent of U.S.
alcoholics. Tend to be in their mid-twenties, had early onset of
regular drinking, and alcohol problems. More than half come from
families with alcoholism, and about half have a psychiatric diagnosis
of Antisocial Personality Disorder. Many have major depression,
bipolar disorder, and anxiety problems. More than 75 percent smoked
cigarettes and marijuana, and many also had cocaine and opiate
addictions. More than one-third of these alcoholics seek help for
Functional subtype: 19.5 percent of U.S. alcoholics.
Typically middle-aged, well-educated, with stable jobs and families.
About one-third have a multigenerational family history of alcoholism,
about one-quarter had major depressive illness sometime in their
lives, and nearly 50 percent were smokers.
Intermediate Familial subtype: 19 percent of
U.S. alcoholics. Middle-aged, with about 50 percent from families
with multigenerational alcoholism. Almost half have had clinical
depression, and 20 percent have had bipolar disorder. Most of these
individuals smoked cigarettes, and nearly one in five had problems
with cocaine and marijuana use. Only 25 percent ever sought treatment
for their problem drinking.
Chronic Severe subtype: 9 percent of U.S. alcoholics.
Comprised mostly of middle-aged individuals who had early onset
of drinking and alcohol problems, with high rates of Antisocial
Personality Disorder and criminality. Almost 80 percent come from
families with multigenerational alcoholism. They have 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 these
alcoholics seek help for their drinking problems, making them the
most prevalent type of alcoholic in treatment.
The authors also report 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.
Other co-authors of the study include Chiung M. Chen, M.A. and
Hsiao-Ye Yi, Ph.D., of the Alcohol Epidemiologic Data System at
CSR Inc., in Arlington, Virginia.
The National Institute on Alcohol Abuse and Alcoholism, part of
the National Institutes of Health, is the primary U.S. agency for
conducting and supporting research on the causes, consequences,
prevention, and treatment of alcohol abuse, alcoholism, and alcohol
problems and disseminates research findings to general, professional,
and academic audiences. Additional alcohol research information
and publications are available at www.niaaa.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.