“In order to differentiate alcoholism not just…along a timeline, but also… across groups of people, thus distinguishing types of alcoholics in a way that ran quite counter to the AA emphasis on the unity of alcoholics, Jellinek came up with the idea of grouping different drinking patterns and naming them by giving each a Greek letter.”
~ Mariana Valverde, Diseases of the Will: Alcohol and the Dilemmas of Freedom
E. Morton Jellinek was an alcoholism researcher who coined the term “the disease concept of alcoholism“, and his 1960 book on the subject, The Disease Concept of Alcoholism, helped further the idea that Alcohol Use Disorder needs to be treated medically as any illness, rather than as a moral deficiency or weakness of character. Jellinek identified five progressive stages of alcoholism –
- Alpha – The person is psychologically dependent upon alcohol to relieve emotional and/or physical pain.
- Beta – The drinker suffers from the physical damage caused by chronic alcohol abuse – blackouts, cirrhosis of the liver, etc. – but they do not have a physical or psychological dependence.
- Gamma – The alcoholic loses all control when consuming alcohol AND has a severe physical dependence.
- Delta – Rather than “losing control”, alcoholics at this stage will be unable to refrain from drinking.
- Epsilon – The most advanced stage of alcoholism, presenting as uncontrollable cravings resulting in periodic incidents of compulsive excessive drinking.
A Modern Analysis
“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. The classification system described in this study will have broad application in both clinical and research settings.”
~ Dr. Ting-Kai Li, M.D., Former Director of the National Institute of Alcohol Abuse and Alcoholism
In the past, identification methods for alcoholic subtypes focused on drinkers who were hospitalized or receiving some other type of medical treatment.
But the NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions indicate that just 25% of alcoholics ever receive any type of treatment. This means most alcoholics – and their subtypes – were never represented in earlier research.
The NESARC is a nationally-representative survey that looks at alcohol, drug, and mental disorders in America. Roughly 1500 respondents from different parts of the country who meet the medical criteria for a diagnosis of Alcohol Use Disorder were included—both receiving and not receiving treatment.
Based upon family history of alcohol abuse, age at initiation of use, patterns of personal use/abuse, and the cooccurrence of substance abuse and mental disorders, researchers identified several distinct alcoholic subtypes.
This subtype makes up nearly a third of American alcoholics – 31.5%. As a group, they have a relatively low rate of dual diagnoses, fewer instances of familial alcoholism, and only rarely seek specialized treatment for their illness.
This subtype comprises around one-fifth of all alcoholics in the United States – 21%. They are typically in their middle-twenties and possess a history including an early initiation of alcohol abuse. Over 50% have family history of AUD and half have been also diagnosed with an Antisocial Personality Disorder. Many Young Antisocials also struggle with anxiety, depression, or bipolar disorder.
Three-fourths smoke – both tobacco and marijuana – and many have an addiction to opioids for cocaine. Unlike “Young Adults”, however, over a third of these seek professional help.
Representing 19.5% of alcoholics, this subtype tends to be older. The typical Functional alcoholic is middle-aged, well-educated, possessing of a good job, and lives what appears to be a “normal” family life.
A third of Functional alcoholics have a multi-generational family history of alcohol abuse. One-fourth have a history of depression. Half are smokers.
Comprising 19% of alcoholics in America, the typical Intermediate Familial alcoholic is middle-aged. Half have a family history of multi-generational alcohol abuse.
Roughly 50% meet the criteria for a clinical diagnosis of depression, while 20% battle bipolar disorder. Most smoke, and a one-fifth have used cocaine or marijuana.
Just 1 out 4 And Intermediate Familial alcoholics ever seek professional treatment.
Making up just 9% of alcoholics in this country, the Chronic Severe subtype highlights the profound negative impact of both genetics and early initiation of use.
Most Chronic Severe alcoholics are middle-aged and have a personal history with an early onset of problem drinking. 80% of individuals within this subtype have a family history of multi-generational alcoholism.
Chronic Severe alcoholics have the highest rates co-occurring mental disorders, including anxiety, depression, bipolar disorder, and antisocial personality disorder.
Most smoke, and many also abuse marijuana, cocaine, and opioids such as heroin or prescription painkillers.
Among all alcoholic subtypes, the Chronic Severe alcoholic is the most likely to seek treatment – two-thirds will go to alcohol rehab.
What Does All of This Mean?
Because alcoholism has been identified as a disease, determining the exact manifestation and severity gives addiction specialists a powerful tool that can shape more personalized and effective treatment.
And when a person fully understands that their drinking problem is an illness – and not a moral weakness – classification shows them that their disease did not come out of nowhere. Genetics, environment, personal habits, and mental health history all contributed.
But identification also helps by letting the alcoholic know that they are not alone. There is help and support available to help them successfully recover from their illness.
In Southern California, the best resource for individuals and families in crisis is Chapman House Treatment Centers. Located in Orange County, Chapman House has provided premium alcohol, drug, and behavioral health treatment since 1978.
If you or someone you care about needs help, contact Chapman House TODAY.