Two Types of Alcohol Dependence

I have never met two active alcoholics that are the same. Although their lies and deceit can be predictable, there will always be a spectrum of personality characteristics that will differentiate each person. You might argue that aggression would be a common trait seen in alcoholics, but I would have to disagree. Horatio, for example, is rarely found exhibiting aggressive behavior when he is loaded up (this may be because all of his aggression is directed inward).

The Diagnostic and Statistical Manual (DSM IV) has historically divided alcohol abuse patterns in to either alcohol abuse or alcohol dependence. In short, the individual that succumbs to alcohol abuse has a life that is not as impaired as someone with alcohol dependence. The latter individual will be so affected by the substance being in their system that they will demonstrate physiological dependence on the drug i.e. tolerance and withdrawal.

Many in the mental health community further argue that the alcohol dependent patient can be qualified as either of two types. I personally disagree with having two nice and neat categories for the same reason that I don’t feel that people with alcohol addiction can be minimized to having only a narrow spectrum of personality traits. However, it is good to discuss this topic since it brings up common arguments.

The main areas of focus that differentiate the two groups include:
Genetic predisposition
Age of onset
Pattern of onset
Gender
Severity
Personality traits
Risk of abusing multiple drugs.

Type 1
There is less evidence of a genetic predisposition in this patient. Their drinking pattern is usually attributed to events in their life such as losing a job, financial hardship, or stressors at home. The use of alcohol in this group is to assuage the anxiety produced in their life, however, this behavior acts as a positive reinforcement which quickly leads to dependence. The ratio of males to females in type 1 is equivalent, and the severity of alcohol dependence is less as compared to type 2. The personality characteristics commonly seen in type 1 include a tendency to feel anxious, shy, pessimistic, sentimental, emotionally dependent, rigid, reflective, and slow to anger.

Type 2
There is more evidence of a genetic predisposition in this group. The onset of heavy drinking is often before the age of 25. Their pattern of drinking is not necessarily related to stressful events because they commonly drink regardless of the situation. This group is predominately composed of men and often there is a history of fights and arrests. The degree of alcohol dependence is severe as well as a greater risk of abusing other drugs. Type 2 is associated with people that usually don’t experience guilt, fear, or loss of control over their drinking. They tend to be impulsive, aggressive risk takers, quick-tempered, optimistic and excitable.

After reading this, it may be hard not to think that the point of this post was to fit each person neatly in to a single category. That’s actually quite the opposite of my thoughts. It’s more important to realize that there are some similarities between alcoholics. We may find ourselves relating to one type, or the other, or to both. You are a unique individual, and it is better to understand yourself outside of criteria or characteristics.

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46 comments
  1. I wonder about those alcoholics who would be Type I by this scale who have traumatic events in childhood: abuse, incest, violence at home.

    I agree that there are more than two types, when we take personality etc into consideration. The single most aggressive genetically predisposed alcoholic I ever worked with is a woman. She had varying degrees of intoxication but was rarely ever without some booze in her system. yet she held down a job and worked harder than most 2 people, to ensure she always had her supply. and she started drinking at 10 or 11.

    I look forward to the time when we get really really good information about addiction – perhaps then we can identify it before it takes control of its victims.

    • I think about that too. I know that there are many bloggers that I’ve found with amazing stories of childhood traumatic expereiences. Makes me wonder if I would have crumbled whereas these writers are using it as a strength.

      It is amazing to see functional alcoholics that are some of the more successful people in society. It would have to take a huge amount of motivation to be able to feel like crap and work as hard as those people do.

      Absolutely about learning more on addiction. There just isn’t enough information about it now. I look forward to that day as well.

      PS I’m enjoy the fact that, much like myself, you’re a very introspective person as well. I think your blog will be one of my new favorites!

      • I hope my blog is one of your favorites, for in reading yours, I feel I have found a kindred spirit – someone with an intellectual desire to know more and with the personal experience to ‘get it’ – which I often find lacking in the experts.

        Looking forward to becoming better acquainted as we travel this road.

  2. In my experience, i’ve seen two types of alcoholics as well. Those that need to drink every day and seem to be physically addicted. These are the kind that drink at breakfast and get DTs if they don’t have a ‘fix’. Then there are the binge drinkers, who are more mentally addicted and use alcohol as a crutch, vacation and hiding place.

    i was definitely the second kind…

    • I agree, those would definitely be the two broad categories that most people fall in to.
      I feel that within those two categories, there is a lot of diversity.

    • Al, BOY am i glad those days are over for you and me!

  3. When i read this pre-packaged info. i think … erm WAY too clinical and/or specific for defining alcoholism. Maybe this is more of a Treatment model than a Qualifying model.

    I think alotta folks qualify that aren’t in any particular category listed above. THANKS for the info. mel

    • Exactly. Not every person will fall in to these categores. And they are very clinically oreinted. It’s to be able to fit a person in a category so that they can more easily find a treatment plan. Unfortunately, it doesn’t necessarily mean the person perfectly fits in to that category.

      • True, and no treatment plan works perfectly for each person. Same disease, different animals: all of us :-)

  4. Thank you AGAIN for posting very relevant info. I do not think there is a simple way to categorize alcoholics. I have known too many to think that.

    I was a highly functioning drunk and drug user. I had a very successful career, never had a hangover etc. Most of the people in my family were/are also very successful highly functioning drunks. The reason I quit, wasn’t because of any ‘hitting bottom’ experience that you often hear of in AA meetings. I quit because in therapy, I came to understand that though I looked successful on the outside, on the inside I was a mess. I wanted to be close to people and began to see that I was self medicating to hide childhood pain.

    I think that when you read blogs of recovered addicts who had child hood trauma, it is important to know that most of us found our strength after much soul searching and personal work. We also had to be strong as children to survive. I recommend looking at the LIST ACA blog, in particular the characteristics of an Adult Child of Alcoholics. Children who grow up with trauma often become perfectionistic, controlling and become very hard workers. These are often traits that are valued in our culture BUT are also characteristics that keep us feeling separate and hinder our ability to have real intimate relationships. They are characteristics that we developed as a way of coping in a crazy environment.

    By the way, ACA is grown to include not just adult children of alcoholics, but anyone who grew up in dysfunctional homes.

    I LOVE your blog and what you are doing. It does my heart good to know that you will go out into the world as a doctor who has looked at addiction in depth. THAT is what is needed. I am grateful to you for what you are doing here!

    Peace, Jen

    • Jennifer, you are fucking awesome. Just thought i’d say, brilliant statement. XOXOX mel

      • Lol thank you, iamnotshe, for writing what we were all thinking :-)
        iamnotshe, you’re amazing as well!

        • Mel is a tad bit biased….

          YOU are also Awesome Mr. Nonmalefience!
          (May I have your name?)

          I LOVE this Blog World thing.

          • Haha the blog world has definitely become a part of my life.
            Bartholomew

          • really bartholomew? i’m buying it … along with the Brooklyn Bridge.

          • LIKE. Thumbs up, etc. ;-)

          • haha okay, you got me. Bartholomew is my middle name. Peter is my first name :-P

    • Wow. “though I looked successful on the outside, on the inside I was a mess. I wanted to be close to people and began to see that I was self medicating to hide childhood problems” That speaks so many words than most people are not able to release in a life time. If your parents were so honest and introspective with themselves, maybe they would have changed (not that it would have any affect on you now)

      I have no doubt that you and others had to be strong as children. I’ve been reading the characteristics of ACA and many of the points that you made really stuck out to me as well. One of the more sad points that stuck out to me was the one regarding, “we live life from the viewpoint of victims and are attracted by that weakness in our love and friendship relationships.” There seems to be a wide range of trauma that you and others had to endure. I feel for you.

      I wanted to say that one of your last blog entries about dark humor and finding your friend Mel really struck me. I’ve also noticed that I stick to people with similar humor. I’ve never thought about that in any more depth until today as to why these people have such a similar taste for laughs. I am still trying to figure it out.

      PS I think it’s a great thing with what you’re doing. You’re using the blog world to educate as well as to let us experience your talents and strengths.

      • I think all we can do, and it is not trivial, is break the cycle with our children and in our relationships. That whole ‘sins of the father’s’ thing just gets old. I am very grateful to have an amazing therapist who has helped me understand that my parents actually did the best they could with what they had to work with. It is true.

        I must say that being involved with ACA has been life changing. The characteristics and how we use them for good or ill, are dead on. I have had to really look at myself in a way that has changed the way I relate to others. I tend to be controlling (my husband would laugh at that wording I will tell you right now… TEND to be? I am.) I need to change the way I used the coping skills I learned as a child. I am learning. I have changed AND when something happens, my mother dying of alcoholics dementia for example, I revert back to my old patterns. It is an on going cycle.

        Humor: It IS a connecting point isn’t it? I wonder if it is one of the primal things we are hardwired to look for in Tribe.

        Thank you by the way for all the research and great writing you do! I shared your post today on my blog. Knowledge is power to be sure. I have learned an awful lot from you. I look forward to learning more and more…

        How you manage to do this, keep tabs on your brother AND handle med school is beyond me. you must be superman!

        Have you chosen a specialty yet?

        Jen

        • It’s so very true, your parents did do the best they could with what they had to work with. If we could go back as omnipotent observers, I’m sure that we’d see that your parents always loved you, despite not being in the right condition/state to be able to express it, or anything. We shouldn’t assume that our parents did not try.

          Not superman at all. We all work hard, including yourself. And it’s honestly not as much work now that I am 4th year. My main obligation now is to apply to residency programs and articulate my strengths at interviews. And even that part is nearly over.

          I am applying for Psychiatry residency. This coming week will be relatively life changing for me as the match list comes out. On Monday, the 12th, I’ll find out if I matched in to a program, and then on Friday, the 16th, they will tell me which program I matched in to. It could be any of the 15 programs that I interviewed for. I have my fingers crossed that I’ll get my number one program :-)

          • Bartholomew! OH I will howl at the old moon and say some prayers AND cross my fingers!

            Please keep us POSTED (ho ho!) on what you find out. YOU will make an excellent Psychiatrist. It does my heart good to know you will be out there helping people!

            on the other note: They did do what they could with what they had. My therapist was smart NOT to throw that out right away, but waited until I had some grip and had gotten some of the anger out. It IS true

            She also told me that as kids we had to believe we were: Devils in Heaven not Angels in Hell.

            Meaning: as a kid I had to think it WAS me not them to survive. If I had been able to see how truly dysfunctional it all was it would have been just too much to live with.

            I was a Devil in Heaven. Now I can be an Angel who was living through hell because I have a
            support system and emotional and psychological tools at my disposal. I can handle the truth.

            OK! The 12th!!!!

            On the old calendar…

            Jen

          • Go get it! … like Jen, fingers crossed! You and Jen are having some really interesting exchanges of info here. Sorry to but in. Jen, i bookmarked your meditation technique (this was in your response to another writer here).

            And thank you both for being SO HONEST (as usual) for sharing your experiences with alcohol. It is amazing when people WILL talk about their addictions without shame. It is what it is/was … you give me strength to keep sharing about bulimia. Our addictions are most certainly life changing any way you deal and/or treat it … and if you don’t … probably life “challenging” even ending in bad, bad ways.

        • Eden said:

          I’m sorry to break in here, Jen, but I needed to thank you for expressing the point about parental love. It’s true that children of addicts grow up feeling they have to be stronger and are often more focused and ambitious than other children. Part of the price of that is that many (especially the ones who become addicts themselves) of these people doubt the love of their parents. But we all need love, and we all want to give it… And so few people know how to give love, whether because of perceived expectations (“If I can’t buy her a diamond ring and a house in the country, how can she really know I love her?”) or because of anger at those expectations, or… The reasons are as numerous as there are people, But we need to look for the good…

          Your statement that your parents did the best they could with what they had at the time is powerful because it frees you from needing them to “fix” things. Especially necessary for those people whose parents are gone… And far too many people I know need their parents to fix things, yet those parents passed away long ago. So they remain broken…

          • Very well written, Eden. Many people do remain broken when they don’t have to be. If only they could find solace too.

          • Eden,

            I think you are exactly right. As an ACA (adult child of alcoholics) I do need to realize that it is up to me to ‘fix things’. Now, also as an ACA I tend to want to FIX everything and everyone. I DO need to be clear about only fixing me. In ACA, and in therapy, it is all about re-parenting yourself. I am SICK of talking about/thinking about my ‘inner child’ BUT it was that work in therapy that got me where I am today: not all the way fixed but far from broken. Without a gifted therapist, all my 12 step work would have only gotten me so far….

            Re-parenting myself, learning to mother myself, has saved my life. I saved my life and I am still doing it today.

            As a spiritual person, forgiveness plays into my growth also. Without re-parenting I doubt I would have found it in myself to forgive my mom on her death bed. Now, I STILL struggle with 100% forgiveness 100% of the time BUT I am closer to it thanks to therapy.

            GOOD mental health caregivers WE NEED THEM! Go Bartholomew!

            Jen

          • Eden said:

            I’m so glad to hear you are finding your way through forgiveness (I say “through” because I believe it is a long process that hardly has started at the utterance of the words “I forgive you”). And yes, yes, listen to her, Bartholomew! We need GOOD mental health caregivers.

            Something in your description of your relationship with your mother made me think of this. A friend of mine made this video a while to express her feelings about her own troubled journey with her mother. While your styles are very different, you may find it somewhat therapeutic to watch. Like you, she’s still passing through forgiveness. http://www.shadowrhythms.org/2011/12/forgiveness-i-forgive-you-and-me.html

            Best to you (all),
            Eden

      • I’m so sorry i made a comment about your name! I thought you were being under cover?? I feel like such a poop! Bart is a unique name … as are you.

        I have a huge bridge and no where to put it. It cost (or costed) a fortune. My face! Eating crow here for breakfast. Mia culpa

        Mel

        • Mel,
          You shouldn’t be sorry. I honestly don’t mind. The only reason that I didn’t use my real first name before was because I was applying for residency positions. They have a tendency to do their research on you and I didn’t want them to have any further reason to question my application.

          It’s a good bridge, you should keep it :-)

          Peter

          • Thank you for forgiving me. I feel like a schnook.

            Oh, and btw, i also agree with what Heidi said about caring doctors. You are a rare breed indeed. Good luck with residency searching :-) melis

    • Jen,
      You’re always too kind to me. I truly appreciate your thoughtfulness and your wonderful blog.

      Bartholomew (Peter)

  5. It gives me hope that we will have a Dr who has a clue! After ‘confessing’ that I was trying to cut back on my consumption of wine, my Dr wrote out a prescription slip for my yearly anti-depressant and said, “Actually red wine is good for the heart. You could have two glasses a day, instead of the one.”

    Two problems here at least. One, I’d lied about the quantity. Please do not expect an alcoholic to tell his truth about consumption. Two, I was already needing the prescription and he was adding additional alcohol???

    Probably, there are other issues here, but I was so happy to think I had a reason to add to my bottle a day!

    • It always makes me a bit more sad when I hear those kinds of stories of visits to the doctor. They just don’t take the extra few seconds to ask a little bit more and find out what is really going on. In fact, it’s one of my fears that I will one day end up like that. So tired of the job that I don’t appreciate each and every person that takes their time to come in. Please come kick me if that happens.
      Thank you for your kind words.

  6. Thanks for a very interesting article. The Type I and Type II categories sound like Bob Cloninger at Washington U. in St. Louis. If I recall correctly, Cloninger hoped to predict at least some alcoholics by using the TriDimensional Personality Questionairre, which measures traits like harm avoidance, reward dependence, attraction to novelty. I believe it wasn’t successful.

    From my reading, the search for a unitary “alcoholic personality” is a graveyard for grand ideas. The longitudinal study summarized by Vaillant seemed to put an end to that. Alcoholism takes people from vastly different backgrounds and of diverse character and causes them to behave in remarkably similar ways.

    Don’t know if it’s of interest, but here’s a link to a very short piece we did recently on how the disease concept has evolved since 1960:

    http://treatmentandrecoverysystems.com/nodes/view/slug:evolution-of-a-disease-concept/type:lib

    • Scott,
      Thank you so much for the information. I’ve been trying to figure out the original source so that I can reference them. I’m sure that they have other great research on the topic as well.

      PS great article on evolution of alcoholism. I double majored in psychology and biology in undergrad because I enjoy learning this type of material. It really defines who we are and gives us an understanding of our motivations and drives.

      Thanks again for the info. You wouldn’t mind if I reference you at a later point in time, would you?

  7. I don’t fit into many categories. I’ve never been aggressive. But they say “depression is anger towards one’s self.”
    I never lost a job, didn’t become homeless, and “functioned” effectively.
    But I crashed cars, sat behind bars, and appeared in court without many knowing.
    I drank every day. If I didn’t, the hangover was insane. The withdrawals were not like the DTs of someone who has to drink in the morning, noon and night just to function. But it was, withdrawal, and took days to even feel remotely normal. I would usually drink again though, because it was less painful.
    I come from a family of 4 girls of which I am the youngest. We are all alcoholics of varying degrees. 3 out of 4 were also bulimic. It’s so interesting to me, because I’m the only one who talks about it.
    One sister “uses” alcohol very responsibly. She has trained herself not to get too drunk, to drink water in between, and she has zero guilt about it. She totally enjoys her drinking and makes no apologies. I tried all those methods. They didn’t work for me. And I at times felt shame for my drinking, while at other times, pure defiance.
    I love reading your blog.
    TC

    • I’m glad you talk about it. It makes such a huge difference when you’re able to verbalize things that are deep inside. I’ve been wanting to read up on the EMDR therapy that you do. It sounds really interesting and it seems to be bringing up a lot of memories/emotions for you.
      I love your blog as well. You have a style about your writing that I really enjoy. I hope you keep it up.

      • Thank you. Yes, the EMDR stuff is intensely different from regular talk based therapy. I will write about more. Tomorrow is only my 4th visit and I feel a bit…..physically drained when I get home on Mondays. It will be a process!

        • I could not agree more! I have used both EMDR and Brain Spotting with my therapist and it is the ONLY thing ( besides a 2 hour a day Vipassana meditation practice..) that has begun to Really touch my PTSD responses. I think brain spotting (an outgrowth of EMDR) is nothing short of miraculous. Meditation was very effective but very hard to keep that intense a practice as a busy mom/woman. Anything less than 2 hours did not really impact my PTSD. Regular meditation does help my anxiety.

          Bartholomew, good luck tomorrow! My fingers are crossed!

          Peace, Jen

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