alcohol use disorder Archives -
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Understanding Alcoholism: 5 Different Subtypes of Alcoholics

Understanding Alcoholism: 5 Different Subtypes of Alcoholics

(This content is being used for illustrative purposes only; any person depicted in the content is a model)

“Alcoholic” is the kind of term that a lot of people jokily use to describe their friend who has a few too many drinks one night, or something they say dismissively to make light of their own drinking binges. But does the average person truly understand what it means to be an alcoholic? Alcohol addiction might not seem as serious to some people, but alcoholism is truly devastating and far more complicated than you may think. Partly because people often assume that all alcoholics are the same.

So first, let us look at how alcoholism is commonly defined. Then, let us look at 4 different problem drinkers to see how alcoholics can be quite different.

Understanding Alcoholism

Alcohol use disorder (AUD) has been more commonly known for decades as alcoholism. Alcoholism is frequently used as a more broad term for any drinking of alcohol that results in physical and/or mental health problems. At one point, the Diagnostic and Statistical Manual of Mental Disorders (DSM) divided alcoholism into two types of disorders:

  • Alcohol abuse
  • Alcohol dependence

The most recent version is DMS-5, which integrates these two disorders into one definition of alcohol use disorder. That DSM-5 also identifies levels of mild, moderate and severe sub-classifications. According to the DSM-5, anyone meeting two of the 11 criteria for AUD in the same 12-month period would receive a diagnosis of AUD.

These 11 criteria include:

  1. Had times when you ended up drinking more, or longer, than you intended
  2. More than once unable to stop drinking when you wanted to or tried to stop
  3. Spent a lot of time drinking, being sick from drinking, or recovering from the aftereffects of drinking
  4. Wanting a drink so badly you cannot think of anything else
  5. Drinking or being sick from drinking often interferes with taking care of your home, family, job, school responsibilities
  6. Continuing to drink even though it causes trouble with family and friends
  7. Giving up or cutting back on interests and activities in order to drink
  8. Getting into situations that increase your chances of getting hurt while or after drinking
  9. Continuing to drink despite feeling depressed or anxious, adding to another health problem, or having memory blackouts
  10. Needing to drink much more for the same effect
  11. Experiencing alcohol withdrawal symptoms when the effects of alcohol wear off

Then the severity of the AUD is defined as:

  • Mild

Mild alcoholism is the presence of 2 to 3 of these symptoms.

  • Moderate

Presence of 4 to 5 of these symptoms suggests moderate alcoholism.

  • Severe

The presence of 6 or more of these symptoms is an indication of severe alcohol use disorder.

5 Subtypes of Alcoholism

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is part of the National Institutes of Health (NIH). This organization has actually identified what it believes are 5 subtypes of alcoholism to help expand on our understanding of this complex disease. By looking at how alcoholism can manifest in different forms, a person can learn how to identify warning signs, and how to look for a personalized treatment program that fits their needs.

  1. Young Adult

According to the NIAAA, the largest percentage of alcoholics actually falls into this category, with 31.5% of alcoholics in America. Nearly 1/3 of all alcoholics fit into this subtype.

This group is typically late teens and early 20s. Often these young adults are likely college students. The Centers for Disease Control and Prevention (CDC) reports:

  • Underage drinkers between the ages of 12 and 20 regularly consume more alcohol at a time than older drinkers
  • 90 percent of the alcohol consumed by this group is through binge drinking

Binge drinking is often perpetuated by underage and young adult drinkers. People who fall into the young adult alcoholic subtype rarely have alcoholism in their family history, and they may also be less likely to seek help for their excessive drinking as it is often considered “normal” as a “phase of life” that family members and adults may not take seriously.

  1. Young Antisocial

This type of alcoholic is typically someone in their mid-20s who started drinking alcohol at an early age. With anyone, alcohol impacts brain chemistry, and regular exposure can actually change the way the brain’s circuitry works.

Young brains do not have a fully developed prefrontal cortex, meaning young people can have more difficulties controlling emotions and impulses. They are also more likely to take bigger risks. So excessive drinking may interfere with normal brain development, and increase the odds of substance abuse and addiction.

Unlike the young adult subtype, more than half of the young antisocial alcoholics have a family history of alcoholism.

Many people in this category suffer from a mental health disorder. Around half of the young antisocial subtype also struggle with an antisocial personality disorder. If someone is struggling with a co-occurring mental health disorder, the risk of developing alcoholism or a substance use disorder (SUD) is elevated. Other co-occurring disorders frequently found in this category include:

Around 3/4 of this subtype will also use tobacco and/or marijuana. They may also struggle with opioids or cocaine addictions.

  1. Functional

Around 19.5% of the alcoholic population in the country will fall into the category of the functional alcoholic. These are typically middle-aged, well-educated, and seemingly well put together individuals. They may have a seemingly stable home life with a loving family. Functional alcoholics probably have a steady job and appear to have their lives together. They do not fit into the common stereotype of alcoholism.

Around 1/4 of this subtype of alcoholics have at least one major depressive episode in their lives. However, functional alcoholics are also often good at hiding emotional distress and issues with drinking.

Usually, a functional alcoholic will consistently fulfill most of their regular obligations. In fact, their family may even enable their drinking by making excuses for them when issues related to alcohol abuse do come up. The fact that they are able to appear successful will make it much harder to convince them that they have a drinking problem. Thus, many functional alcoholics will not seek help.

  1. Intermediate familial

This subtype is also typically made up of middle-aged alcoholics. Around half of these individuals come from families with multigenerational alcoholism. Close to 1 out of every 5 intermediate familial alcoholics also struggles with marijuana and cocaine abuse. Many of these individuals also have co-occurring mental health disorders.

  • Nearly half of all intermediate familial alcoholics have struggled with clinical depression
  • 20% have battled bipolar disorder
  • Many others struggle with obsessive-compulsive disorder and generalized anxiety disorder

A lot of intermediate familial alcoholics may use alcohol as a way to self-medicate the difficult emotional symptoms of their mental health disorders.

  1. Chronic severe

When people use the term alcoholic, this is the subtype they most commonly associate with it. Surprisingly though, chronic severe alcoholics only make up 9% of the entire alcoholic population of America.

So really, that stereotype of alcoholism actually represents the minority of alcoholic drinkers.

Chronic severe alcoholics are comprised mostly of middle-aged individuals who had early onset of problem drinking. This subtype experiences high rates of Antisocial Personality Disorder and criminality. Furthermore, nearly 80% of the chronic severe alcoholics come from families with multigenerational alcoholism. This group has the highest rates of other psychiatric disorders, including:

  • Depression
  • Bipolar disorder
  • Anxiety disorders

Chronic severe types also experience high rates of dependence with:

  • Tobacco
  • Marijuana
  • Cocaine
  • Opioids

This is alcoholism to an extreme. Thankfully, this is the subtype with the highest rates of admission to alcohol addiction treatment.

Why Alcohol Addiction Treatment Matters

According to the NIAAA, in 2015 over 6% of American Adults met the criteria for AUD. Sadly, less than 10% of those people struggling with alcoholism received professional treatment. Those numbers alone show how much having alcohol addiction treatment matters. Each subtype will have unique experiences, which means they can greatly benefit from a recovery plan that is custom made for their unique needs. A functional alcoholic may want a treatment plan that incorporates their family. A chronic severe alcoholic may be suffering from a serious health condition that requires more of a focus on medical care.

The truth is, for how devastating alcoholism can be, it is troubling that so few people actually get the help they desperately need. Alcohol withdrawal symptoms are not just uncomfortable, but they can be dangerous and even life-threatening depending on the severity. That is why safe medical detox for alcohol is such a key component of a treatment program.

With all of those subtypes who experience co-occurring mental health disorders, it is critical that they have access to dual diagnosis treatment opportunities. For these individuals, it is important that treatment is not exclusively focused on alcoholism, but also addresses their mental health. Dual diagnosis treatment is designed to simultaneously treat co-occurring conditions while also providing comprehensive care and support for recovering from alcohol addiction. For those with co-occurring disorders, only treating one while ignoring the other can be counterproductive. An untreated mental health disorder can ultimately lead an individual to self-medicate. Dual diagnosis treatment isn’t just a better level of care- it is a crucial aspect of relapse prevention.

Regardless of what subtype someone may fit into, it is important that anyone who fits the criteria for alcohol use disorder seek professional addiction treatment. If you or someone you love is struggling, please call toll-free now. We want to help.

CALL NOW 1-888-922-5398

America’s Heavy Drinking: Where Do All 50 States Rank?

America’s Heavy Drinking: Where Do All 50 States Rank?

Even though the country is very aware of the opioid crisis that continues to claim lives every day, one of the most dangerous drugs in America is still alcohol. Heavy drinking in the US is also a deadly epidemic. According to the Center for Disease Control and Prevention (CDC) an estimated 90,000 people die from excessive drinking every year.

Another new report also indicated that those who do die from alcohol abuse actually die an average of 30 years prematurely.

With more deaths related to heavy drinking than any other drug, which states have the highest rates? A new piece released on 24/7 Wall St. from last week went to work ranking all 50 states.

Defining Different Drinking

In order to better understand how troubling the data truly is, we first have to understand what qualifies as “excessive drinking”.

The CDC categorizes an alcoholic drink as something containing 0.6 fluid ounces of pure alcohol. Therefore, the CDC considers excessive drinking to include terms like:

For women, excessive drinking is four or more drinks on a single occasion. For men, it requires five or more drinks in one sitting.

When it comes to “heavy drinking”, by CDC standards:

  • Women consume at least eight alcoholic drinks per week
  • Men consume at least 15 alcoholic drinks per week

24/7 Wall St. analyzed CDC data on heavy drinking, along with census bureaus and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to create their report. What it shows is that 18% of Americans drink excessively, but that the difference between states it dramatic.

America’s Heavy Drinking States

  1. Tennessee

  • Adults drinking excessively: 11.2%
  • Alcohol-related driving deaths: 28.0% (11th lowest)
  1. West Virginia

  • Adults drinking excessively: 11.4%
  • Alcohol-related driving deaths: 32.0% (25th lowest)
  1. Utah

  • Adults drinking excessively: 12.4%
  • Alcohol-related driving deaths: 19.7% (the lowest)
  1. Alabama

  • Adults drinking excessively: 13.0%
  • Alcohol-related driving deaths: 29.4% (17th lowest)
  1. Mississippi

  • Adults drinking excessively: 13.3%
  • Alcohol-related driving deaths: 23.3% (3rd lowest)
  1. New Mexico

  • Adults drinking excessively: 13.8%
  • Alcohol-related driving deaths: 32.1% (25th highest)
  1. Oklahoma

  • Adults drinking excessively: 13.9%
  • Alcohol-related driving deaths: 29.9% (19th lowest)
  1. North Carolina

  • Adults drinking excessively: 14.9%
  • Alcohol-related driving deaths: 32.3% (24th highest)
  1. Arkansas

  • Adults drinking excessively: 15.3%
  • Alcohol-related driving deaths: 28.4% (13th lowest)
  1. Idaho

  • Adults drinking excessively: 15.4%
  • Alcohol-related driving deaths: 28.4% (23rd highest)
  1. Maryland

  • Adults drinking excessively: 15.5%
  • Alcohol-related driving deaths: 32.8% (20th highest)
  1. Nevada

  • Adults drinking excessively: 15.8%
  • Alcohol-related driving deaths: 32.8% (21st highest)
  1. Arizona

  • Adults drinking excessively: 16.0%
  • Alcohol-related driving deaths: 27.6% (9th lowest)
  1. Kentucky

  • Adults drinking excessively: 16.3%
  • Alcohol-related driving deaths: 28.5% (14th lowest)
  1. South Carolina

  • Adults drinking excessively: 16.4%
  • Alcohol-related driving deaths: 37.8% (7th highest)
  1. Delaware

  • Adults drinking excessively: 16.6%
  • Alcohol-related driving deaths: 37.9% (6th highest)
  1. Indiana

  • Adults drinking excessively: 16.8%
  • Alcohol-related driving deaths: 23.6% (5th lowest)
  1. Georgia

  • Adults drinking excessively: 16.8%
  • Alcohol-related driving deaths: 23.4% (4th lowest)
  1. Kansas

  • Adults drinking excessively: 16.9%
  • Alcohol-related driving deaths: 27.3% (8th lowest)
  1. Texas

  • Adults drinking excessively: 17.3%
  • Alcohol-related driving deaths: 29.9% (8th lowest)
  1. Virginia

  • Adults drinking excessively: 17.4%
  • Alcohol-related driving deaths: 30.5% (20th lowest)
  1. Florida

  • Adults drinking excessively: 17.4%
  • Alcohol-related driving deaths: 28.2% (12th lowest)
  1. Wyoming

  • Adults drinking excessively: 15.5%
  • Alcohol-related driving deaths: 35.3% (10th highest)
  1. New Jersey

  • Adults drinking excessively: 17.6%
  • Alcohol-related driving deaths: 24.3% (20th lowest)
  1. Missouri

  • Adults drinking excessively: 17.7%
  • Alcohol-related driving deaths: 31.7% (23rd lowest)
  1. South Dakota

  • Adults drinking excessively: 17.7%
  • Alcohol-related driving deaths: 35.2% (11th highest)
  1. Washington

  • Adults drinking excessively: 17.8%
  • Alcohol-related driving deaths: 35.0% (12th highest)
  1. Rhode Island

  • Adults drinking excessively: 17.9%
  • Alcohol-related driving deaths: 40.4% (3rd highest)
  1. California

  • Adults drinking excessively: 18.0%
  • Alcohol-related driving deaths: 29.0% (15th lowest)
  1. Pennsylvania

  • Adults drinking excessively: 18.1%
  • Alcohol-related driving deaths: 32.0% (24th lowest)
  1. New York

  • Adults drinking excessively: 18.2%
  • Alcohol-related driving deaths: 23.0% (2nd lowest)
  1. New Hampshire

  • Adults drinking excessively: 18.4%
  • Alcohol-related driving deaths: 31.2% (22nd lowest)
  1. Connecticut

  • Adults drinking excessively: 18.6%
  • Alcohol-related driving deaths: 33.4% (18th highest)
  1. Louisiana

  • Adults drinking excessively: 18.8%
  • Alcohol-related driving deaths: 32.6% (22th highest)
  1. Oregon

  • Adults drinking excessively: 18.8%
  • Alcohol-related driving deaths: 32.8% (19th highest)
  1. Colorado

  • Adults drinking excessively: 19.1%
  • Alcohol-related driving deaths: 34.7% (13th highest)
  1. Ohio

  • Adults drinking excessively: 19.2%
  • Alcohol-related driving deaths: 34.3% (14th highest)
  1. Massachusetts

  • Adults drinking excessively: 19.5%
  • Alcohol-related driving deaths: 27.8% (10th lowest)
  1. Vermont

  • Adults drinking excessively: 19.6%
  • Alcohol-related driving deaths: 33.4% (17th highest)
  1. Maine

  • Adults drinking excessively: 19.6%
  • Alcohol-related driving deaths: 39.8% (4th highest)
  1. Michigan

  • Adults drinking excessively: 20.0%
  • Alcohol-related driving deaths: 29.4% (16th lowest)
  1. Nebraska

  • Adults drinking excessively: 20.4%
  • Alcohol-related driving deaths: 35.6% (9th highest)
  1. Hawaii

  • Adults drinking excessively: 20.5%
  • Alcohol-related driving deaths: 38.0% (5th highest)
  1. Iowa

  • Adults drinking excessively: 21.0%
  • Alcohol-related driving deaths: 25.4% (7th highest)
  1. Minnesota

  • Adults drinking excessively: 21.1%
  • Alcohol-related driving deaths: 30.9% (21st lowest)
  1. Illinois

  • Adults drinking excessively: 21.2%
  • Alcohol-related driving deaths: 34.2% (15th highest)
  1. Montana

  • Adults drinking excessively: 21.8%
  • Alcohol-related driving deaths: 46.3% (2nd highest)
  1. Alaska

  • Adults drinking excessively: 22.1%
  • Alcohol-related driving deaths: 33.8% (16th highest)
  1. Wisconsin

  • Adults drinking excessively: 24.5%
  • Alcohol-related driving deaths: 36.9% (8th highest)
  1. North Dakota

  • Adults drinking excessively: 24.7%
  • Alcohol-related driving deaths: 46.7% (the highest)

What State Stats Tell Us

Looking at some of the data, you might be surprised at where some of these states ended up in the rankings. One thing that comes to no surprise is that the state with the highest rate of excessive drinking- North Dakota- also has the highest rates of alcohol-related driving deaths.

But there are things that you might not be able to tell from these numbers at face value. For one, the director of the NIAAA George Koob claims,

“There is a clear correlation between a state’s excessive drinking rate and income.”

For example, the top 25 states with higher drinking rates also have similarly high median household income. Out of those 25, 14 of them have incomes that exceed the national average of $57,617. Compare that to the 10 states with the lowest drinking rates, with 9 of them having household incomes well below that same average.

However, Koob cautions us not to see this correlation too cut and dry, stating:

“If you look at individuals, the [drinking-to-household income] pattern is somewhat different.”

Someone may look at the report and suggest that affluent individuals frequently drink to excess, however, they don’t appear to drink as heavily. In fact, it seems low-income individuals drink to excess less frequently, but when they drink, they drink heavily more consistently.

Overall, we should take notice of just how prevalent excessive drinking is in different areas all over the country.  In 2016 the population of North Dakota (#1 on the list) was around 757,952. Based on this number, 24.7% excessive drinking comes out to around 187,214 adults. Even with Tennessee, the state with the lowest rate, the numbers are pretty serious. With a 2016 population of 6.651 million, 11.2% comes out to 744,912 adults drinking excessively. So almost the entire population of North Dakota.

We have to be able to acknowledge risk behavior like excessive and heavy drinking in order to help those who may be struggling with alcohol use disorder. With alcohol doing real damage to so many lives in every corner of America, providing treatment programs for those struggling with alcohol use disorder is incredibly important. If you or someone you love is struggling with alcohol abuse or addiction, please call toll-free now. You are not alone.

 CALL NOW 1-888-922-5398

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