Reviewed by Yehuda Roberts
August 6, 2024
Types of Alcoholics: Dismantling Stigmas
Explore the types of alcoholics: understanding subtypes, co-occurring conditions, and tailored treatments.
Understanding Alcohol Use Disorder
Before delving into the various types of alcoholics, it's crucial to first understand the overarching issue at hand, Alcohol Use Disorder (AUD).
Defining Alcohol Use Disorder
Alcohol Use Disorder (AUD) is a chronic, relapsing brain disorder characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It encompasses the conditions that some people refer to when they describe a person as being an "alcoholic."
AUD ranges from mild to severe, with severity based on the number of symptoms experienced. Symptoms can include strong cravings for alcohol, prioritizing drinking over other activities, and increased tolerance or experiences of withdrawal symptoms.
Excessive alcohol consumption associated with AUD leads to significant functional impairment and morbidity. It is a serious public health issue and ranks as the third leading cause of preventable death in the U.S. [1].
Prevalence of Alcohol Use Disorder
AUD is prevalent, affecting a significant portion of the U.S population. Approximately 12.5% of males and 5% of females in the United States meet the criteria for an AUD in the past year. Throughout their lifetimes, an estimated 42% of males and 20% of females experience an AUD [1].
These figures highlight the pervasiveness of AUD in society and underscore the importance of recognizing the different types of alcoholics to better understand and address this disorder. Understanding the types of alcoholics allows for more effective interventions and treatments tailored to the specific needs of individuals.
Subtypes of Alcoholism
Understanding the different types of alcoholics is crucial to provide effective treatment and support. In this section, we will explore the five subtypes of alcoholism, focusing specifically on Type 1 and Type 2 alcoholism, and Type A and Type B alcoholism.
Five Subtypes of Alcoholism
Alcoholism is not a one-size-fits-all condition. Its manifestations can vary significantly from one individual to another. Different classifications have been proposed to categorize these variations, including the Type 1-Type 2 typology and the Type A-Type B typology.
Type 1 and Type 2 Alcoholism
The Type 1-Type 2 typology was developed from a study of Swedish adoptees and their biological and adoptive parents. Type 1 alcoholism affects both men and women, requires a genetic predisposition, commences later in life after years of heavy drinking, and can take on either a mild or severe form. This type is associated with high anxiety levels, as indicated by high harm avoidance, low novelty seeking, and high reward dependence personality traits. Type 1 alcoholism is also associated with binge drinking, loss of control over drinking, excessive guilt about drinking, and rapid progression from mild to severe alcohol abuse, often accompanied by the development of alcoholic liver disease.
On the other hand, Type 2 alcoholism mainly affects sons of male alcoholics, is influenced weakly by environmental factors, often begins during adolescence or early adulthood, is characterized by moderate severity, and is associated with criminal behavior. This type is often associated with low harm avoidance, high novelty seeking, and low reward dependence, which is consistent with antisocial personality disorder. Type II alcoholism is characterized by more moderate alcohol abuse, frequently accompanied by fighting and arrests, and does not change in severity over time as type I alcoholism does.
Type A and Type B Alcoholism
Babor's classification of alcoholism categorizes individuals into two types: Type A and Type B. Type A alcoholism is considered less severe, with a later onset, a weaker family history of alcoholism, and less impulsive behavior.
On the other hand, Type B alcoholism is typically more severe, with earlier onset, stronger family history of alcoholism, more impulsive behavior, childhood conduct problems, severe dependence, multiple drug abuse, and co-occurring psychiatric disorders, especially antisocial personality disorder.
Both gender and race play a role in alcoholism typologies. More women are classified as Type A alcoholics (62%) compared to men, and the proportion of Type A individuals varies between men and women. In terms of race, the Type A-Type B distinction is meaningful for both black and white populations. While blacks are more often categorized as Type A alcoholics (74%), the dimensions between the types are consistently more different for blacks compared to whites.
Understanding these subtypes can be instrumental in tailoring treatment approaches and strategies to the specific needs of the individual. Each subtype comes with its unique set of challenges and treatment considerations, underscoring the importance of personalized care in addressing alcohol use disorder.
Alcoholism, Genetics, and Environment
When discussing the various types of alcoholics, it's crucial to consider the role of both genetics and environmental factors. Each contributes distinctively to the development and progression of alcohol use disorders (AUDs).
Genetic Factors in Alcoholism
Alcoholism, also referred to as alcohol dependence or alcohol use disorder, is a complex genetic disease. Twin studies consistently find moderate to high heritability of drinking behaviors, indicating a significant genetic influence on alcohol consumption and the risk for AUDs [1].
Certain genes have been identified to affect the risk of alcoholism, including ADH1B and ALDH2, both of which are involved in alcohol metabolism. However, these genes only account for a small percentage of the variance in drinking outcomes within specific samples [4].
Moreover, twin studies suggest that approximately 45-65% of the liability for alcohol dependence is due to genetic factors. Adoption studies also show that alcoholism in adoptees correlates more strongly with their biological parents than their adoptive parents [4].
In terms of specific genetic influences, the ADH1B48His allele and the ADH1B370Cys allele are known to have a protective effect against alcohol dependence. These alleles metabolize ethanol at higher rates than the reference allele and reduce the risk for alcoholism [4].
Environmental Factors in Alcoholism
In addition to genetic factors, environmental influences play a significant role in the development of AUDs. Environmental restrictions, such as social norms promoting abstinence and restricted availability of alcohol, are hypothesized to dampen the expression of genetic influences on drinking behaviors [1].
Furthermore, the social context can act as a stressor that enhances the behavioral expression of genetic vulnerability to risk for alcohol consumption and AUDs. This makes individuals with genetic risk more sensitive to the effects of environmental stressors.
In essence, alcoholism is a complex interplay between genetics and environment. Understanding this relationship can aid in the development of prevention strategies and treatment approaches for different types of alcoholics. It's important to note that while genetics may predispose an individual to alcoholism, it does not guarantee that a person will develop an AUD. Similarly, even in the absence of a genetic predisposition, certain environmental factors can still increase the risk of alcoholism. Therefore, both factors must be considered when addressing alcoholism and related disorders.
Alcoholism and Co-occurring Conditions
Those struggling with alcohol use disorders, or types of alcoholics, often face additional health challenges, both mental and physical. These co-occurring conditions can complicate the individual's situation and require integrated care strategies for effective treatment.
Co-occurring Mental Health Disorders
It's well-documented that alcoholism often co-exists with various mental health disorders. A striking example is the high comorbidity between alcohol dependence and depression. Individuals with major depressive disorder have higher rates of alcohol use disorder. This interconnection suggests that these conditions may feed off each other, with one potentially exacerbating the symptoms of the other.
Research also indicates that other mental health conditions, such as anxiety disorders, bipolar disorder, and schizophrenia, may also have higher prevalence rates among those with alcohol use disorders. Understanding these overlapping conditions is crucial in developing effective treatment strategies.
Alcoholism and Physical Health
Excessive alcohol use, beyond the immediate intoxicating effects, can have a profound impact on physical health over time. Alcohol abuse is associated with significant functional impairment and morbidity, ranking as the third leading cause of preventable death in the U.S..
Chronic heavy drinking can lead to a host of health problems, including liver disease, heart disease, stroke, and certain types of cancer. Additionally, alcohol can impact the body's nutritional status, leading to deficiencies that can further damage overall health.
It's evident that alcoholism doesn't exist in a vacuum. It often co-occurs with other mental health disorders and can lead to severe physical health problems. Therefore, a holistic approach that addresses all aspects of the individual's health is essential in the treatment of different types of alcoholics. Comprehensive care strategies can help individuals achieve recovery and lead healthier, more fulfilling lives.
Treatment Approaches for Different Types
Effective treatment for alcoholism often requires understanding the specific subtype of the disorder that an individual is dealing with. Customizing treatment approaches to align with these subtypes can significantly enhance the effectiveness of the treatment programs [6].
Tailoring Treatment to Subtypes
Type 1 and Type 2 alcoholics exhibit different patterns of behavior and response to stimuli, which can impact the most effective treatment strategies for these individuals.
For instance, Type 1 alcoholics, who typically exhibit high levels of anxiety, might benefit more from controlled drinking strategies. This group is often characterized by binge drinking, loss of control over drinking, excessive guilt about drinking, and rapid progression from mild to severe alcohol abuse.
On the other hand, Type 2 alcoholics, often associated with antisocial personality disorder, typically require abstinence-based treatment programs due to their more severe and complex alcohol-related issues. This group is characterized by more moderate alcohol abuse, frequently accompanied by fighting and arrests.
The key to effective treatment lies in accurately identifying the subtype of alcoholism and tailoring treatment approaches accordingly.
Pharmacological Treatments for Alcoholism
Pharmacological treatments for alcoholism can be particularly effective when used in conjunction with behavioral therapies. These treatments can help manage withdrawal symptoms, reduce cravings, and restore normal brain function. While these medications are not a cure for alcoholism, they can be a valuable tool in the recovery process.
However, it's important to note that the efficacy of these treatments can depend on the subtype of alcoholism. For instance, research has shown that Type II alcoholics exhibit lower activity levels of the enzyme monoamine oxidase (MAO), which is involved in metabolizing certain brain chemicals, compared to Type I alcoholics. This could potentially influence how these individuals respond to certain medications.
As with any treatment plan, the use of pharmacological treatments should be under the supervision of a healthcare professional. This ensures that the medication is being used safely and effectively, and that any side effects are properly managed.
The treatment approach for alcoholism should be comprehensive, addressing not only the physical aspects of the disorder but also the psychological and social factors. By understanding the specific subtype of alcoholism and tailoring treatment approaches accordingly, it's possible to provide more effective and targeted support to those struggling with this disorder.
References
[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192029/
[2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876531/
[3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876529/
[4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056340/
