For the first time, federal researchers have broken down the disease of alcoholism into five distinct subtypes, which experts say should help provide more targeted treatment for problem drinkers.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported June 28 that the five new subtypes include "Young Adult," "Young Antisocial," "Functional," "Intermediate Familial," and "Chronic Severe."

"Our findings should help dispel the popular notion of the 'typical alcoholic,'" said study lead author Howard B. Moss, M.D., associate director of NIAAA's Clinical and Translational Research division. "We find that young adults comprise the largest group of alcoholics in this country, and nearly 20 percent of alcoholics are highly functional and well-educated with good incomes. More than half of the alcoholics in the United States have no multigenerational family history of the disease, suggesting that their form of alcoholism was unlikely to have genetic causes."

"Clinicians have long recognized diverse manifestations of alcoholism, and researchers have tried to understand why some alcoholics improve with specific medications and psychotherapies while others do not," added NIAAA Director Ting-Kai Li, M.D. "The classification system described in this study will have broad application in both clinical and research settings." 

Moss and colleagues developed their subtypes based on survey respondents' family history of alcoholism, age of onset of regular drinking and alcohol problems, symptom patterns of alcohol dependence and abuse, and the presence of additional addictive and mental disorders.

They found that 31.5 percent of alcoholics in the U.S. fall under the Young Adult subtype, who have relatively low rates of other drug or mental-health problems, low rates of family alcoholism, and rarely seek help for their drinking. The Young Antisocial subtype accounts for 21 percent of alcoholics, the researchers said; this category includes drinkers in their mid-20s who tend to have early onset of drinking, a family history of alcoholism, mental-health problems, and co-occurring tobacco or illicit-drug use. This group was more likely to have sought help for drinking than the Young Adult subtype.

Members of the Functional subtype, accounting for 19.5 percent of alcoholics, are typically middle-aged and well-educated, with stable jobs and families. They are relatively likely to have a family history of alcoholism and a personal history of major depressive illness in their lives, and about half are smokers. A similar percentage (19 percent) of American alcoholics fall into the Intermediate subtype, who are middle-aged and more likely to have a family history of alcoholism and mental illness than the Functional subtype. Most are smokers, problems with other drug use is relatively common, and about a quarter have sought help for their drinking.

The final subtype identified by Moss and colleagues, Chronic Severe, covers 9 percent of alcoholics. Most are middle-aged, with early onset drinking, high rates of antisocial personality disorders and criminality, and a strong family history of alcoholism. This subtype is typified by the highest rates of mental-health problems, smoking, and illicit-drug use, and two-thirds of this group has sought treatment for their drinking problems.

The NIAAA subtypes report is published online in the journal Drug and Alcohol Dependence.