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5 Different Subtypes of Alcoholics: Understanding the Differences and Implications

5 Different Subtypes of Alcoholics: Understanding the Differences and Implications

The five alcoholic subtypes—young adult, young antisocial, functional, intermediate familial, and chronic severe—require different approaches to AUD treatment.

Alcohol use disorder (AUD) is a serious health condition that can take over your life or that of someone you love. Recognizing the signs and symptoms of AUD is crucial so you can get help before the problem worsens. However, that can be tricky because there are five subtypes of AUD, and each may appear somewhat different. Familiarizing yourself with the different AUD subtypes can help you spot the need for intervention, such as alcohol rehab, earlier on.

Regardless of the AUD subtype you fall into, medication-assisted treatment for alcohol use can help. And with Confidant Health, you can get the support you need right from home. Download our app to enroll in our online medication-assisted treatment program. You’ll enjoy convenient, effective AUD treatment and guidance from a recovery coach.

Understanding Alcohol Use Disorder

Alcohol use disorder is a chronic condition in which a person cannot stop drinking even after experiencing adverse effects. Alcohol misuse can lead to health problems, financial worries, and even job loss, but once a person is addicted, they may find it impossible to quit. AUD often involves binge drinking and heavy drinking, although this is not always the case. Drinking more than moderate amounts of alcohol can increase the chances of dependence or addiction. 

What Causes Alcohol Use Disorder?

Alcohol use disorder is caused by changes in the brain that make a person crave alcohol and depend on it for positive mood and relaxation. The addiction cycle occurs in three stages: incentive salience, negative emotional states, and executive function.

Incentive Salience

During the first stage, a person experiences the mood-boosting effects of alcohol, which activates the basal ganglia and makes them want to drink more. Over time, they associate certain people, places, or things with alcohol consumption and enhanced sociability, euphoria, and relaxation. These physiological and learned behaviors lead to cravings and dependence.

Negative Emotional States

This second stage involves the withdrawal symptoms a person experiences when they stop drinking after becoming addicted. The basal ganglia have become reliant on alcohol for activation; without it, a person may feel anxious and irritable. The lack of alcohol can also activate the extended amygdala, making them feel more stressed. The negative emotional states in this second stage are bothersome enough that a person turns to alcohol to alleviate the discomfort, continuing the addiction cycle.

Executive Function 

The prefrontal cortex is largely responsible for the third stage of the addiction cycle. This area of the brain involves a person's decision-making and time-management skills. When the prefrontal cortex is impaired due to addiction, the person becomes fixated on consuming alcohol and when they can have their next drink. When that next drink comes, they circle back to stage one, and the addiction cycle continues.

Symptoms of Alcohol Use Disorder

How can you distinguish between occasional alcohol misuse and alcohol use disorder? People with AUD exhibit the following signs and symptoms:

Inability to Moderate Alcohol Consumption 

You may intend to limit yourself to just one or two drinks when you go out but often find that you can't stop after that point.

Alcohol Monopolizes Your Time

Alcohol may become a focal point in your life, and social activities revolve around drinking. This can also mean that much of your time is spent recovering from the effects of alcohol, with hangovers or withdrawal symptoms.

Alcohol Affects Work or School

When you have developed AUD, your mental and physical health can suffer, making it more difficult to keep up with work or school responsibilities. This can eventually result in job loss or failing classes. 

Developing Tolerance to Alcohol

Over time, you may need to drink more alcohol to achieve the same relaxing or euphoric effect. This indicates you have developed a tolerance to your usual amount.

Experiencing Withdrawal Symptoms 

If you try to reduce your consumption or quit alcohol cold turkey and experience withdrawal symptoms, you have likely developed AUD. Your body has become dependent on alcohol and responds with physical and psychological discomfort when alcohol is cut off. Some common alcohol withdrawal symptoms include sweating, shaking, nausea, irritability, and anxiety. These symptoms can be mistaken for hangovers, but withdrawal lasts much longer, sometimes up to a week or two.

Who May Be at Risk of Alcohol Use Disorder?

Anyone who misuses alcohol can develop an alcohol use disorder, but some people are more prone to this chronic disease. Some factors that increase the risk of AUD include:

  • Family history of alcohol misuse, alcohol use disorder, or another substance use disorder
  • Family or personal history of mental health conditions
  • Childhood trauma or mental health conditions
  • Binge or heavy drinking

Being aware of your risk of AUD can help you make changes to your drinking behaviors and address risk factors that are within your control. Preventative measures are much easier than trying to cut back on drinking after you have become dependent or addicted to alcohol. 

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5 Subtypes of Alcoholics

Young Adult Alcoholic

Young adults comprise the largest portion—31.5%—of people with alcohol use disorder in the United States. And within that group, college students are most likely to engage in alcohol misuse and develop AUD.

According to the Substance Abuse and Mental Health Service Administration's (SAMHSA) 2019 National Survey on Drug Use and Health (NSDUH), 33% of college students aged 18 to 22 binge drank in the past month, while 8.2% reported heavy drinking. Out of people in the same age range who did not attend college, 27.7% binge drank in the past month, and 6.4% reported heavy drinking.

The young adult subtype is less likely to seek treatment because binge, heavy, and frequent drinking are often viewed as a normal part of socializing in one's teens and early twenties. For many young adults, this is a temporary phase they grow out of once they take on the responsibilities of supporting themselves, building a career, and starting a family. But those that develop alcohol use disorder will struggle to stop drinking regardless unless they get professional help.

Young Antisocial Alcoholic

The young antisocial subtype makes up the second largest percentage of Americans with alcohol use disorder, coming in at 21%. Individuals in this group tend to be in their mid-20s with a high incidence of co-occurring disorders and polysubstance misuse.

The label "young antisocial" refers to antisocial personality disorder, which half of the people in this group exhibit. The Mayo Clinic describes those with this mental health disorder as showing "no regard for right or wrong" and "no guilt or remorse for their behavior."

Functional Alcoholic

The next largest subtype is functional alcohol use disorder, making up 19.5% of people with AUD. This is often the most challenging type of alcohol use disorder to notice because people with functional AUD tend to hold down successful jobs and relationships. Since they appear to be doing well, others may not notice they struggle with drinking. 

Intermediate Familial Alcoholic

The intermediate familial subtype makes up 19% of Americans with alcohol use disorder. They tend to be middle-aged with a higher chance of clinical depression and a family history of AUD. Only a small fraction of this group seeks treatment.

Chronic Severe Alcoholic

The smallest subtype is chronic severe alcohol use disorder, comprising only 9% of Americans with AUD. They are mostly middle-aged with high rates of co-occurring disorders including antisocial personality disorder. This group also has the highest likelihood of a family history of alcohol use disorder. Since their condition is the most serious, people with chronic severe AUD are also the most likely to seek treatment.

Alcohol Use Disorder FAQs

What do most people with alcohol use disorder have in common?

Beyond problematic drinking behaviors, there are a few traits that are more common among people with AUD. A family history of alcohol use disorder, co-occurring mental health disorders, polysubstance misuse, and smoking were all prominent among the subtypes, with the exception of young adults.

What is the life expectancy of someone with an alcohol use disorder?

Since alcohol use disorder can be detrimental to your health, it can adversely affect your life expectancy. According to the Centers for Disease Control and Prevention (CDC), excessive drinking can shave an average of 29 years off a person’s life in the United States. 

How much do people with AUD drink on average?

AUD can involve binge or heavy drinking, but some people with this condition do not engage in these drinking behaviors. For some people, simply drinking more than moderate amounts of alcohol can result in an alcohol use disorder. That means a man with AUD averages more than two drinks a day or fourteen per week and a woman with the condition averages more than one drink a day or seven per week. 

What is the average lifespan of someone with AUD?

Several variables can impact the lifespan of someone with AUD, such as the severity of their condition and co-occurring health problems. The CDC estimated that 56% of all alcohol-related deaths in the US from 2011–2015 involved people between 35–64 years of age.

Does drinking every day mean you have an alcohol use disorder?

Drinking in moderate amounts daily—one or fewer drinks for women and two or fewer for men—does not necessarily indicate an alcohol use disorder. However, it can make you more likely to develop AUD, especially if you become tolerant to one or two daily drinks and require larger amounts to achieve the same feeling.

Treatment and Medication for Alcohol Use Disorder

Treatment for alcohol use disorder generally consists of medication, therapy, and support. Medications can help alleviate withdrawal discomfort, treat co-occurring mental health conditions, reduce alcohol cravings, and either block the effects of alcohol or induce unpleasant side effects when alcohol is consumed. 

The provider's AUD treatment approach may differ somewhat according to the client's subtype. Here are a few examples of how treatment can be customized for AUD subtype:

Setting Drinking Goals

People who regularly drink heavily may experience severe or dangerous alcohol withdrawal symptoms if they quit cold turkey. A better approach can be to set goals to taper or gradually lower one’s alcohol intake. This strategy may be most appropriate for anyone currently drinking heavily when they seek treatment, such as the chronic severe subtype.

Assessing Liver Health

Long-term alcohol misuse—most common among the functional, intermediate familial, and chronic severe subtypes—can impair liver function. Unfortunately, some of the standard medications used to treat AUD can increase the burden on the liver as its job is to process food, beverages, and drugs that enter your system. In cases when a person has a long history of alcohol misuse or has existing liver damage, providers may prescribe medications, like topiramate or baclofen, that are less taxing on the liver.

Providing Education

Some young people may not realize that the number of drinks they consume at social events qualifies as alcohol misuse since it has been normalized in their social circle. The young adult and young antisocial subtypes may be less likely to understand the seriousness of alcohol use disorder and how it can affect their physical and mental health long term. The most effective treatment protocol involves educating them about the risks and how chronic alcohol misuse can interfere with their life goals. The provider will also help them set goals for reducing alcohol consumption by explaining the difference between moderate and binge or heavy drinking. 

Considering Family History of AUD

All but the young adult subtype have a high chance of having a family history of alcohol misuse or AUD. Genetics and one's home environment can play a role in a person's risk for AUD and should be addressed in therapy as part of a comprehensive treatment plan.

Addressing Co-Occurring Disorders

The young antisocial, intermediate familial, and chronic severe subtypes are most likely to have co-occurring mental health conditions. Co-occurring disorders like depression, anxiety, and post-traumatic stress disorder (PTSD) can complicate alcohol use disorder. A special treatment approach, known as dual diagnosis treatment, is required to help people achieve their recovery goals. 

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When to Call for Professional Help

Although you may suspect that you or someone you love may need help with alcohol use disorder, you might not think you need a treatment program to reduce drinking. Some people can quit cold turkey or taper their alcohol consumption without much difficulty. This is more likely if someone engages in alcohol misuse but hasn't developed a dependence or addiction. Once they have developed AUD, quitting on their own may seem next to impossible.

Here are a few signs that it is time to call for professional help for alcohol use disorder:

  • You have tried to cut back on or quit drinking more than once without success.
  • You're experiencing alcohol-related health problems or mental health conditions.
  • You need to drink larger amounts of alcohol to get the same buzz.
  • You find yourself drinking more often than intended to fend off withdrawal symptoms.
  • Once you start drinking, you find it hard to stop at just one or two drinks.

The above signs can indicate an addiction to alcohol or that you are dependent and on the path to developing AUD. At this point, it would be safer to seek professional help to prevent complications and reduce the risk of relapse.

How to Help a Loved One Dealing with AUD

Alcohol use disorder is challenging for the individual, but it can also take a toll on family members and friends. Here is how you can help a loved one with AUD:

  • Talk with them about your concerns. Try to focus on your concern for their well-being and use "I" phrases, such as "I feel." This comes across as more loving and less accusatory.
  • Allow them plenty of space to speak without judgment or interruption. 
  • Share information about treatment programs they may be more likely to consider. Some people are uncomfortable attending an in-person program, so you can suggest virtual AUD treatment.

Even if your loved one is not ready to get help for AUD, you can still support them by suggesting alcohol-free activities when you spend time together. And be sure to offer a listening ear and encouragement when they are ready to talk. 

Confidant Health: Customized Virtual Treatment for AUD

Alcohol use disorder looks different for each person, so your treatment should look different too. Confidant Health offers virtual medication-assisted treatment designed to address each individual's needs. Our online alcohol rehab provides you with your very own recovery coach who will guide you every step of the way. Download our app today to find out how virtual medication-assisted treatment for alcohol use can help you achieve your recovery goals.

This article has been medically reviewed by
Erin Hillers
Erin Hillers
Erin Hillers
Nurse Practitioner

Erin is a Nurse Practitioner with 8 years of experience in midwifery and women's health. She has spent the past 5 years specializing in the treatment of opioid and alcohol use disorders.

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