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Researchers Identify Five Alcoholic Subtypes

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) has identified five distinct subtypes of alcohol dependence.

“Clinicians have long recognized diverse manifestations of alcoholism,” said NIAAA Director Ting-Kai, MD, “and researchers have tried to understand why some alcoholics improve with specific medications and psychotherapies while others do not.”

Previous attempts to identify alcoholism subtypes focused on individuals who were seeking treatment. A survey by the NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) included individuals in treatment as well as those not seeking treatment.

The NESARC focused on 1,484 respondents who met diagnostic criteria for alcohol dependence and subtypes were identified based on family history, age of onset of regular drinking and alcohol problems, symptoms and patterns of dependence and abuse, and the presence of additional substance abuse and mental disorders.

Young Adult subtype: Young adult drinkers. Low rates of co-occurring substance abuse and other mental disorders. Low rate of family alcoholism. Rarely seek help for drinking. (31.5% of US alcoholics.)

Young Antisocial subtype: Mid twenties. Early onset of regular drinking and alcohol problems. More than half from families with history of alcoholism. About half have a psychiatric diagnosis of Antisocial Personality Disorder. Major depression, bipolar, and anxiety problems prevalent. More than 75% smoked cigarettes or marijuana. Cocaine and opiate addictions. One third seek help for drinking. (21% of US alcoholics.)

Functional subtype: Middle-aged. Well-educated. Stable jobs and families. Thirty percent have a multigenerational family history of alcoholism. Twenty five percent have experienced major depressive illness. Nearly 50% smoked cigarettes. Percentage who seek help: data unavailable. (19.5% of US alcoholics.)

Intermediate Familial subtype: Mostly middle-aged. About half from families with multigenerational alcoholism. Around 50% have had clinical depression, and 20% have had bipolar disorder. Most smoked cigarettes, and nearly one in five had problems with cocaine and marijuana use. About a quarter of Intermediate Familial subtypes seek treatment. (19% of US alcoholics.)

Chronic Severe subtype: Most middle-aged. Early onset of drinking and alcohol problems. High rates of Antisocial Personality Disorder and criminology. Around 80% come from families with multigenerational alcoholism. High rates of other psychiatric disorders including depression, bipolar disorder, and anxiety disorders. High rates of smoking and marijuana, cocaine, and opiate dependence. Two-thirds seek helped for their drinking problems. The most prevalent type of alcoholic in treatment. (9% of US alcoholics.)

According to Director Ting-Kai, the classification system described in this study will have a broad application in both clinical and research settings.

The National Institute on Alcohol Abuse and Alcoholism, part of the National institutes of Health, is the primary US 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 http://www.niaa.nih.gov/.

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