Alcoholism is a substance use disorder that involves abuse, dependency, and addiction to alcohol. However, addiction affects everyone differently, so one person who is diagnosed with alcohol use disorder may have a vastly different experience from someone else with the disorder. Alcoholism is a complex disease that requires a complex treatment plan to address effectively. Does that mean there are different kinds of alcoholism? And is there such a thing as a “functioning alcoholic?”
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Learn more about alcohol use disorders and how they can affect people differently.
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5 Types of Alcoholism
A pioneering study conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) studied 1,484 people who met the diagnostic criteria for alcohol dependence. From those results, they were able to identify five subtypes of people who suffer from alcoholism. The clinical term for alcoholism is known as alcohol use disorder (AUD).
“Our findings should help dispel the popular notion of the ‘typical alcoholic,’” notes one of the authors of the study. “We find that young adults comprise the largest group of [people who struggle with alcoholism] in this country, and nearly 20 percent of [people who suffer from alcoholism] is highly functional and well-educated with good incomes. More than half of the [individuals who suffer from alcoholism] in the United States have no multigenerational family history of the disease, suggesting that their form of alcoholism was unlikely to have genetic causes.”
The five most prevalent subtypes include:
The Young Adult Subtype: This is the largest subtype, which accounts for about 32 percent of people who suffer from alcoholism in the U.S. They rarely seek help for their alcohol dependence. While they drink less frequently than others who suffer from alcoholism, they tend to engage in binge drinking. What’s more, they tend to have low rates of family alcoholism and have relatively low rates of co-occurring substance abuse or mental health disorders, according to Verywell Mind.
The Young Antisocial Subtype: On average, this subtype is 26-years-old and comprise about 21 percent of all people struggling with alcoholism. More than half have an antisocial personality disorder. They also tend to suffer from conditions such as anxiety, major depression, and bipolar disorders. They likely began drinking at 15 and developed alcohol use disorders by 18, earlier than other subtypes. They are also more likely to smoke marijuana and tobacco.
The Functional Subtype: This subtype accounts for about 19 percent of all people who suffer from alcoholism in the U.S. What’s consistent about individuals who fit this type is that they tend to be middle-aged, working adults who have stable relationships, more education, and higher incomes than other subtypes. Verywell Mind notes that nearly 50 percent are smokers and about one-quarter of them have had a major depressive illness at some point in their lives.
The Intermediate Familial Subtype: About 19 percent of people who struggle with alcoholism fit this particular subtype. People in this category typically started drinking by 17 and developed alcoholism in their early 30s. What’s more, nearly half of the people in this category have close relatives who struggle with alcoholism. Some other patterns that emerged regarding this subtype are that close to half have had clinical depression, and about 20 percent have had bipolar disorder. Most people in this group smoke cigarettes and almost one in five reportedly use cocaine and marijuana.
The Chronic Severe Subtype: Considered the rarest subtype, people in this category account for about nine percent of all individuals struggling with alcoholism in the U.S. What’s unique about this group is that it mainly consists of men. This subtype also has the highest rates of divorce and frequently use illicit drugs like marijuana, cocaine, and illicit opiates. People from this subtype also have the highest rates of psychiatric disorders like depression, anxiety, and bipolar disorders.
The Functioning Alcoholic
There is an idea that some people can have alcohol use disorder in a way that is functional and doesn’t interfere with their daily lives. This myth is perpetuated by portrayals of characters in movies and TV that just need a drink, and then they’ll be able to get the job done. However, the myth of the high-functioning person with alcoholism is more fiction than fact.
It’s true that an alcohol use disorder can affect people at different levels at different times. A mild alcohol use disorder is anyone who develops a habit of binge drinking without necessarily being chemically or psychologically addicted. This is common among young adults and college students.
According to a 2015 national survey, more than 37 percent of full-time college students have binged alcohol within the past month of the survey. Also, 32 percent of college-age young adults (ages 18-22) who were not in college also binged alcohol in the same time frame.
College binge drinking has been a significant problem for years. However, even though binge drinking is considered a mild alcohol use disorder, people aren’t graduating from college addicted to alcohol in percents as high as thirty or more. Binging comes with its own serious risks and consequences like alcohol poisoning, increased risk-taking, and a higher percentage of being involved in an automobile crash. However, it’s possible for some to binge drink for a certain amount of time without becoming addicted.
On the other hand, some people who have alcohol use disorders struggle to make it through the day without a drink. Their bodies are dependent on alcohol, and their brains have adapted, too. If they have become addicted, they will also have a psychological dependence on alcohol.
However, if you’ve developed a level of alcoholism where you need to drink to feel normal, as is the case with psychological or chemical dependence, it will start to affect multiple aspects of your life in a way that severely hampers your “functionality.” You may find yourself scheduling your day around alcohol. It may start to affect when you can safely drive, your work or school performance may suffer, and you may start to have health problems. If you are struggling to adapt your life around substance abuse, you are no longer in control of it; it’s in control of you.
If you feel like you need a psychoactive substance to function, you’re hardly high-functioning. Plus, the longer alcoholism wears you down, the more it will affect your life. Addiction slowly starts to take over every aspect of your life, causing physical, psychological, social, legal, and financial problems. If you have seen signs of an alcohol use disorder in your life, the only way to continue functioning in a fulfilling life is to address it, not to accept it. That being said, even severe alcohol use disorders can be effectively treated, and you don’t have to live in active addiction forever.
The Levels of Alcohol Addiction
Alcoholism, like all substance use disorders, exists in three levels of severity, according to the Diagnostic and Statistical Manual of Mental Disorder (DSM-5). Alcohol use disorders are diagnosed as mild, moderate, and severe depending on the number of signs and symptoms present. According to the DSM-5, there are 11 signs that you may have substance use disorders, and the number of them that applies to you determines the severity of your disorder. The signs are 11 questions about your past year use, including:
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- Drinking more or longer than you intended to.
- Trying and failing to cut back or stop drinking.
- Spending a lot of time either drinking or getting over the effects of drinking.
- Wanting to drink to the point of not being able to think about or focus on anything else.
- Drinking interfered with your ability to fulfill responsibilities at work, home, or school.
- Continuing to drink even when it causes social problems with family or friends.
- Cutting back on usual hobbies or interests to spend more time drinking.
- Gotten into risky situations while or after drinking that put you in danger more than once. (e.g., risky sexual encounters, drinking and driving, swimming, operating heavy machinery)
- Continuing to drink even though it’s causing depression, anxiety or adding to other mental or physical problems, or causing memory blackouts.
- Needing to drink more than you once did to achieve the same desired effects.
- Experiencing withdrawal symptoms like insomnia, shakiness, restlessness, nausea, sweating, seizures, or palpitations when alcohol has worn off.
The presence of two to three symptoms is indicative of a mild substance use disorder, four or five symptoms are moderate, and six or more symptoms are considered severe. However, different symptoms may indicate different aspects of a substance use disorder. If you have drunk more than you intended and engaged in risky behavior while drinking with no other symptoms, you may just be engaging in alcohol abuse with no physical dependence.
If it takes more alcohol for you to achieve the desired effects or if you experience withdrawal symptoms when the alcohol wears off, you may be physically dependent. This means your brain is reliant on alcohol to maintain normal chemical functioning. Without it, your brain chemistry is thrown off until it readjusts back to normal, which can be an uncomfortable and even dangerous process.
Finally, if you continue to use alcohol even as it’s disrupting your life through health issues, getting in the way of personal responsibilities, or by causing relationship problems, you may be addicted. Addiction is defined as compulsive behavior despite problems that come as a direct result of that behavior.
Technically, alcoholism is another word for an alcohol use disorder. The disease is progressive, and people can find themselves at different stages of the disease or different severities. However, it’s all the same disease. Still, the best way to address alcoholism is to tailor treatment plans to the specific needs of an individual. There is no one-size-fits-all addiction treatment solution. If you see some of the signs of alcoholism in your life, it’s important to seek help as soon as possible.
Seeking Help for Alcoholism
If you or someone you know is struggling with a substance use disorder involving alcohol, it’s important to seek help as soon as possible. Alcohol can cause potentially dangerous withdrawal symptoms if you go through them without medical treatment. There is help available to give you more information about alcohol detox and addiction treatment.
Speak to an addiction treatment specialist at Serenity at Summit to learn more about the therapy options that may be available to you or a loved one. A call may be the first step toward addiction recovery and long-lasting sobriety. Begin the path to lasting recovery. Call us today at 844-432-0416
American Psychiatric Association. (n.d.). Diagnostic and Statistical Manual of Mental Disorders (DSM–5). from https://www.psychiatry.org/psychiatrists/practice/dsm
National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Use Disorder. from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders
National Institute on Alcohol Abuse and Alcoholism. (2018, August). Alcohol Facts and Statistics. from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics