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Understanding the Five Types of Alcohol Dependence

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Approximately 60% of Americans consume alcohol. Among those aged 12 and older, 10.2% are diagnosed with alcohol use disorder (AUD). The current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) categorizes AUD as mild, moderate, or severe based on how many criteria an individual meets and how severely their daily functioning is impaired. While this classification helps understand the seriousness of AUD, it does not identify the root cause and personality features associated with alcohol use. However, research aimed at understanding the source of alcohol dependence identified five distinct subtypes of alcohol users.

Managing alcohol use disorder can feel isolating and frightening. If you or a loved one identifies with one of the subtypes below, Guardian Recovery has resources to aid your recovery. We offer services such as medical detox12-Step Mentoring, and individualized therapy to help you reach your sobriety and overall wellness goals. 

With an individual focus, we will work with all aspects of your well-being, including mental health, to ensure the best possible outcome. For information about our clinical programs or to learn more about our treatment facilities, contact us today to speak with a Treatment Advisor 24/7.

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Young Adult Subtype

The young adult subtype of alcohol dependence accounts for the most significant proportion (31%) of individuals who misuse alcohol. People in this group are approximately 25 years old, with an average age of 20 for developing alcohol dependence. They are more likely to be male and less likely to have a family history of AUD. Isolated heavy alcohol use or “binge drinking,” where an individual consumes five or more drinks in one day, is common among members of the young adult subtype. In fact, people in this group report having more than 13 alcoholic beverages on drinking days, so while they are not drinking regularly, they are significantly over-consuming on specific occasions.

Compared to other subtypes, young adults have a lower probability of co-occurring mental health diagnoses and legal problems. However, this cluster is apt to engage in moderate marijuana and cigarette use. Only 8.7% of the young adult subtype seek professional help for alcohol use. When they do, they engage in 12-Step groups (e.g., Alcoholics Anonymous) rather than attending individual therapy or a formal rehab program.

Functional Subtype

The second cluster of alcohol-dependent subtypes is the functional group. Members tend to be older males (41 years) with later onset of alcohol dependence (37 years) and the greatest proportion of retirees. These alcohol users frequently consist of college-educated, full-time workers with families. One-third of people reported a family history of alcohol dependence.

These individuals have a moderate likelihood of developing major depressive disorder. Rates of other substance use are low, as are legal problems, although members of this group are more likely to engage in regular cigarette smoking and hazardous activities while intoxicated. They tend to consume a maximum of 10 drinks every other day. Seventeen percent of people in the functional subtype have sought help for their drinking. Much like the young adult group, they also prefer 12-Step programs in addition to professional services.

Intermediate Familial Subtype

Among regular alcohol users, 18.8% belong to the intermediate familial subtype. It is referred to as familial because half of the people in this cluster have a strong, multigenerational family history of AUD. Like the functional subtype, members of the group are commonly older males (average 38 years). They have the most outstanding employment rate and are more likely to be married or divorced than single. Lifetime treatment prevalence is 27%, with a preference for rehab programs, detox, specialty treatment, self-help programs, and private medical treatment.

The co-incidence of major depressive disorder, bipolar disorder, obsessive-compulsive disorder, and anxiety is significant within the intermediate familial subtype. Rates of tobacco, marijuana, and cocaine use are higher relative to other subtypes as well. 

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Young Antisocial Subtype

Like the young adult cluster, the young antisocial subtype is characterized by an early onset of alcohol dependence (18 years) and an average age of 26, in addition to more than half of individuals in this group carrying a diagnosis of antisocial personality disorder (ASPD). 

Individuals With ASPD Can Display the Following Traits:

  • Behavioral/conduct disorders in childhood.
  • Lack of empathy for others.
  • High incidence of impulsive, risky actions.
  • Persistent lying and intentional deception.
  • Using charm or manipulation for personal gain.
  • No appreciation of right vs. wrong.
  • Legal issues/imprisonment resulting from theft, property destruction, and assault/abuse.
  • Aggressive or violent behavior with a lack of remorse for harming others.
  • Inability to have emotionally fulfilling relationships.

In addition to ASPD, major depressive disorder, bipolar disorder, social phobia, and obsessive-compulsive personality disorder are prevalent in this group. Individuals report high cigarette, marijuana, cocaine, methamphetamine, and opioid use with the greatest chance of developing drug and alcohol tolerance. 

Men comprise three-quarters of the young antisocial subtype and have the lowest proportion of marriage and college degrees among all five clusters. Half of these individuals have a family history of alcohol misuse. On drinking days, this group endorses consuming a maximum of 17 drinks, the most of any subtype. More than one-third of alcohol users in this subtype seek treatment for AUD. They prefer self-help groups and detox facilities but utilize private healthcare professionals more than any other subtype.

Chronic Severe Subtype

The chronic severe group is the final and least common subtype (9%) of alcohol dependence.  Like the intermediate familial and functional subtypes, most people in this cluster are middle-aged males (approximately 38 years) who developed addiction around age 16. They have the largest proportion of divorcees and the lowest overall employment rate. More than 75% of members in this group have a multigenerational family history of AUD, exceeding all other subtypes.

Second only to the young antisocial subtype, the chronic severe subtype’s instance of ASPD is 47%. Rates of psychiatric disorders surpass those of the other four groups, most commonly major depressive disorder, dysthymia, bipolar disorder, generalized anxiety disorder, social anxiety, and panic disorder. They are also at an elevated risk for cigarette, marijuana, cocaine, and opioid use. 

This cluster reports the highest number of past-year drinking days, with a maximum of 15 drinks per day. Although this subtype is the rarest, it is the most common type found in treatment. Two-thirds of these alcohol users seek professional help and have the highest attendance rates for self-help programs, detox, specialized treatment, and inpatient-level care.

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Alcohol use disorder is a severe but very treatable condition. If you identify with one or more subtypes of alcohol dependence discussed above, it may be time to consider treatment. The benefits of quitting alcohol are physical and emotional. With the proper therapeutic support and compassionate guidance, you can get the most out of your recovery and be on the way to the healthiest version of yourself.

Help is available 24/7 with Guardian Recovery. Contact us today to learn how our mission to offer personalized, comprehensive treatment can work for you. In addition to supplying a detailed list of services on your journey to sober wellness, we also provide a free, no-obligation health insurance benefit check. Reach out today to see how we can help.

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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.

  1. https://news.gallup.com/poll/353858/alcohol-consumption-low-end-recent-readings.aspx
  2. https://drugabusestatistics.org/alcohol-abuse-statistics/#:~:text=Most%20American%20adults%20consume%20alcohol,Alcohol%20Use%20Disorder%20in%202020.
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094392/
  4. https://www.nih.gov/news-events/news-releases/researchers-identify-alcoholism-subtypes
  5. https://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/symptoms-causes/syc-20353928

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Reviewed professionally for accuracy by:

Ryan Soave

L.M.H.C.

Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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