When you imagine an alcoholic, what image comes to mind? A homeless person begging for change? A middle-aged executive drinking from a flask in their office? A college student partying every night?
These are common stereotypes of what an alcoholic might look like. However, the truth is that alcoholics come in all shapes and sizes, and they don’t fit into one single mold.
In fact, according to a study by scientists from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), there are five different subtypes of alcoholics, each with its characteristics, risk factors, and treatment needs.
- Young Adult Subtype
- Functional Subtype
- Intermediate Familial Subtype
- Young Antisocial Subtype
- Young Antisocial Subtype
These alcoholism subtypes are not official diagnoses, but they can help us understand the different patterns and problems of people who struggle with alcohol abuse. Below you can learn what each one means.
Young Adult Subtype
The young adult subtype comprises young adults between 18 and 25 years old, usually single, and often still in school or working part-time. They tend to drink alcohol less frequently than other subtypes but often binge drink when they do.
They rarely have a family history of alcoholism, but they may have other co-occurring mental health conditions or substance abuse problems. About 31.5% of alcoholics fall into this category, but only 8.9% have ever sought treatment for their alcohol dependence.
Young adult alcoholic is less likely to seek help for their drinking because they may not see it as a serious problem or fear social stigma. If they do seek help, they may prefer online or self-help resources, individual counseling, or peer support groups.
Functional alcoholics make up about 19% of people with alcohol use disorder in the US. They are mostly in their forties or fifties and have stable jobs and families. This subtype is more prevalent among women.
They may have a higher level of education and income than other subtypes and appear to be successful and have it all together. However, they drink heavily and regularly, often to cope with stress or boredom.
They have high rates of education and income, but also high rates of smoking and health problems.
Functional alcoholics may be genetically predisposed to alcoholism and co-occurring depression or anxiety disorders.
Similar to the young adult subtype, they are also unlikely to seek help for their drinking. Only about 1/3 of people in the functional subtype seek treatment for alcohol-related issues as they may deny or rationalize their behavior or fear losing their reputation or status. If functional alcoholics do seek help, they may prefer professional counseling or medication.
Functional alcoholics are more likely to try brief interventions or outpatient specialty treatment programs than inpatient or residential programs.
Intermediate Familial Subtype
The third subtype is the intermediate familial subtype. These are people in their thirties or forties and have a strong family history of alcoholism.
They may have started drinking early and developed a dependence by their 20s. They may also have other substance use disorders. They also tend to smoke cigarettes and use other drugs in addition to alcohol abuse.
Intermediate familial alcoholics may also have other mental health problems such as major depression, bipolar disorder, or generalized anxiety disorder.
They tend to drink frequently and heavily and experience more severe consequences from their drinking, such as health problems, legal troubles, or relationship conflicts.
Someone in the intermediate familial alcoholics subtype is usually employed, but they may have lower levels of education and income than the functional subtype.
About 18.8% of alcoholics fall into this category.
They are more likely to seek treatment for their drinking than the previous two subtypes, as they may recognize the impact of alcohol on their lives and relationships.
They may prefer a combination of professional treatment and peer support groups. They are more likely to try inpatient or residential addiction treatment programs than other subtypes.
Young Antisocial Subtype
The fourth subtype is the young antisocial subtype which makes up about 21% of alcoholics in the US. They are mostly in their mid-twenties and have a history of antisocial behavior such as lying, stealing, violence, or legal problems.
A young antisocial alcoholic may also have other mental health disorders such as personality disorders (like antisocial personality disorder), major depression, bipolar disorder, or attention deficit hyperactivity disorder (ADHD).
They are often unemployed or underemployed and may have low education and income levels. They drink frequently and heavily, often mixing alcohol with other substances.
People in the young antisocial subtype often begin drinking and using drugs at a very young age, and have a history of criminal behavior, violence, or impulsivity.
They have a high rate of relapse and poor treatment outcomes.
They are also more likely to seek help for their drinking than the young adult subtype as a result of legal or social consequences for their actions. They are more likely to try dual diagnosis programs that address their substance abuse and mental health conditions.
Chronic Severe Alcoholic Subtype
Chronic severe alcoholics are the oldest, usually in their late 40s to early 60s and have the most chronic and severe form of alcohol dependence.
This subtype makes up about 9% of alcoholics in the US and have the highest rates of mental health conditions, physical health problems, family history of alcoholism, and co-occurring drug use.
Chronic severe alcoholics drink almost every day and consume alcohol in large amounts. They have multiple physical and psychological problems related to their drinking, such as liver disease, brain damage, or psychosis.
They may also have other substance abuse issues, such as using opioids or cocaine. They have a high divorce rates, unemployment, homelessness, and incarceration.
Chronic severe subtype makes up about 9.2% of alcoholics in the US, and they are the most likely to seek help for their drinking due to life-threatening situations or severe withdrawal symptoms.
They are more likely to try detoxification or medication-assisted treatment than other subtypes. They may prefer programs with intensive medical, psychological care, and long-term follow-up and support.
Looking for a Place to Start?
Are you or your loved ones relating to the five types of alcoholics mentioned above? Don’t worry; you’re not alone, and there’s help available.
Alcoholism is treatable, and Design for Recovery is here to support you. We’re a leading sober living home in Los Angeles offering a safe and supportive environment and different programs people struggling with substance use disorder. We also offer aftercare and ongoing support to ensure you have the tools you need for long-term success.
Take that brave step forward. Contact Design for Recovery today and take the first step towards a healthier and alcohol-free life.
Frequently Asked Questions
The 5 A’s of alcoholism are: Ask, Advise, Assess, Assist, and Arrange. These are guidelines recommended for addressing adolescent alcohol use in primary care.
The 5 A’s model is a framework for brief interventions and conversations with individuals at risk for or experiencing alcohol-related problems. These steps aim guide healthcare professionals in addressing alcohol use disorder and promoting behavior change.
Ask – The first step is to ask the individual about their alcohol use. Healthcare providers initiate conversations to gather information and assess the extent of alcohol consumption, patterns, and potential consequences. This step helps identify individuals with problematic drinking habits and need further evaluation.
Assess – Assessment involves a comprehensive evaluation of the individual’s alcohol use, including its impact on their physical health, mental well-being, relationships, and overall functioning. Healthcare professionals use standardized screening tools, interviews, and discussions to gain a deeper understanding of the individual’s drinking behaviors and associated problems.
Advise – After assessing the individual’s alcohol use, healthcare providers offer advice and provide personalized feedback about the potential risks and consequences associated with their drinking patterns. They discuss the individual’s specific situation, potential health risks, and the benefits of reducing or quitting alcohol consumption. This step aims to increase awareness and motivate the individual to make changes.
Assist – Assistance involves providing support and resources to help the individual take steps towards reducing or eliminating their alcohol use. Healthcare professionals work collaboratively with the individual to develop a plan that suits their needs and goals. This may include providing information about treatment options, counseling, and support groups, or connecting them with specialized addiction services.
Arrange – The final step, arrange, focuses on ensuring that the individual receives appropriate follow-up care and ongoing support. Healthcare providers help individuals make concrete arrangements for accessing further treatment, counseling, or support services. This step emphasizes the importance of continued assistance and long-term support to maintain positive changes in alcohol use.
The causes of alcoholism are multifaceted and can vary from individual to individual. However, some common factors that can contribute to the development of alcoholism include genetic predisposition, environmental influences, psychological factors, social and cultural factors, and the availability and accessibility of alcohol.
Some people may have a higher risk due to their family history, social surroundings, psychological traits, life events, or ways of dealing with problems.
The 5 types of alcoholics, as identified in the NESARC study, can impact treatment approaches and interventions by recognizing the heterogeneity within alcohol addiction. Different types may require tailored interventions based on their specific needs, characteristics, and underlying factors. Treatment may involve a combination of medical interventions, counseling, support groups, behavioral therapies, and addressing co-occurring disorders.
“Delta alcoholic” is a term used by physiologist Elvin M. Jellinek to describe a person who cannot stop drinking once they start. They have a physical dependence on alcohol and experience withdrawal symptoms if they try to quit. A delta alcoholic may also have a high tolerance and need to drink more to feel the effects.
The five different types of alcoholics differ in terms of their drinking patterns and behaviors as follows:
Young adult alcoholics tend to binge drink on weekends or special occasions with friends. They may not drink daily, but consume a lot when they do. They usually don’t have any other mental disorders or legal problems related to their drinking.
Young antisocial alcoholics start drinking at an early age (around 15) and develop an addiction by mid-20s. They often have an antisocial personality disorder or other conduct problems. They may also use other drugs and get into trouble with the law because of their drinking.
Functional alcoholics appear to have a normal life but they regularly drink heavily. They may drink to cope with stress or to enhance their performance. They often deny or hide their problem and may not seek help until they face a crisis.
Intermediate familial alcoholics often have a family history of alcoholism and start drinking young or in their late teens or early 20s. They may also suffer from depression or anxiety disorders. They drink frequently and heavily, but not necessarily every day.
Chronic severe alcoholics are the most severe and chronic drinkers. They usually start drinking in their early teens and have multiple co-occurring mental health disorders such as bipolar disorder, schizophrenia, or antisocial personality disorder. Chronic severe alcoholics drink every day and often throughout the day. They have serious health complications, legal issues, financial troubles, and relationship breakdowns because of their drinking.
An individual can fit into more than one category of the five types of alcoholics. Alcohol addiction can present differently in individuals, and there may be overlapping features or a combination of subtypes within an individual’s drinking patterns and behaviors.
For example, a person may start as a young adult alcoholic but then develop antisocial traits or functional behaviors over time. Or a person may switch from one type to another depending on their life circumstances or stage of recovery.
An individual’s drinking patterns and behaviors can evolve and change over time. For example, a person may start as a functional alcoholic but then become a chronic severe alcoholic as their condition worsens. Or a person may start as a young antisocial alcoholic but then become a functional alcoholic as they mature or seek treatment.
Factors such as personal circumstances, life events, treatment, and environmental influences can contribute to transitions between different alcoholic subtypes, or changes in the severity of their alcohol addiction.
There are distinct differences in the outcomes and prognosis for each type of alcoholic. The outcomes and prognosis for each type of alcoholic can vary based on various factors, including individual characteristics, the severity of alcohol addiction, the presence of co-occurring disorders, access to treatment and support, and personal motivation for change.
For example, young adult alcoholics tend to have better chances of recovery than chronic severe alcoholics because they have less physical damage, fewer co-occurring disorders, and more social support.
Functional alcoholics may have more difficulty admitting their problem and seeking help than most intermediate familial alcoholics because they have more to lose or fear of stigma. Young antisocial alcoholics may have more relapses and legal problems than other types because they have more impulsivity and aggression.
Generally, individuals with more severe and chronic alcohol-related problems, such as those in the chronic severe subtype, may face greater challenges and have a more guarded prognosis. However, it is important to approach each case individually, as outcomes can be influenced by numerous factors.
How Can Understanding the 5 Types of Alcoholics Help in Prevention Efforts and Early Intervention Strategies?
Understanding the five types of alcoholics can help public and private healthcare providers in prevention efforts and early intervention strategies by identifying risk factors, warning signs, and treatment needs for each type.
For example, prevention programs can target young people exposed to genetic or environmental influences that may lead to alcoholism. Early intervention strategies can screen for personality or mental health issues that may increase the likelihood of developing alcohol addiction.
Addiction treatment programs can tailor their approaches and interventions to the specific characteristics and challenges of each type of alcoholic.
American Psychological Association. (n.d.). Jellinek’s alcoholism species . Apa Dictionary of Psychology. https://dictionary.apa.org/jellineks-alcoholism-species
Friedman, J. L., Lyna, P., Sendak, M. D., Viera, A. J., Silberberg, M., & Pollak, K. I. (2017). Use of the 5 As for Teen Alcohol Use. Clinical pediatrics, 56(5), 419–426. https://doi.org/10.1177/0009922816655884
Moss, H. B., & Chen, C. M. (2007). Subtypes of Alcohol Dependence in a Nationally Representative Sample. Drug and alcohol dependence , 91(2-3), 149. https://doi.org/10.1016/j.drugalcdep.2007.05.016