Astudy in press with Drug and Alcohol Dependence provides what may
be the clearest picture yet of Americans with alcohol dependence.
The study analyzed the clinical features of 1,484 Americans found to be
alcohol-dependent t hrough the 2001-2002 National Epidemiological Survey on
Alcohol and Related Conditions and then grouped those persons according to
their clinical features.
The study found that there is no such thing as a "typical
alcoholic," rather that alcohol-dependent subjects tend to fall into
five subtypes—young adult, young antisocial, intermediate familial,
functional, and chronic severe.
In an interview with Psychiatric News, lead researcher Howard
Moss, M.D., associate director for clinical and translational research at the
National Institute on Alcohol Abuse and Alcoholism, said the study's findings
"We were surprised that so many of the individuals who met diagnostic
criteria for alcohol dependence were young adults. We thought we were going to
see a substantial proportion of folks with alcohol dependence being of the
chronic recurring subtype that is seen in Veterans Administration hospitals
and in other kinds of settings where people treat chronic disease. Another
surprise was the breakout in terms of family history of alcohol problems and
the fact that only about half the sample had familial transmission of alcohol
The study results suggest that certain therapies might work better with
certain subtypes than with others, Moss said. In fact, he and his coworkers
will now be attempting to see whether certain types of therapies work best for
this or that subtype. Until such results are obtained, how should individuals
in the various categories be treated?
"The young adult variety may be addressed with screening and brief
intervention techniques rather than much more expensive approaches to
therapeutic intervention," Moss advised. "It may also be—and
again this is speculation, as we have to do the studies—that certain
types of pharmacotherapies that are now available could be better targeted to
this subgroup. For example, this subgroup might benefit from pharmacotherapy
that reduces the reinforcing effect of alcohol."
Since the antisocial group has the worst prognosis of any of the subtypes,
Moss said, "the focus there has to be on complete abstinence and
elimination of other forms of substance abuse and also mainstreaming their
behaviors so that they are much more like the rest of society."
"The functional subtype," Moss emphasized, "represents
individuals who essentially have fewer psychosocial consequences from their
alcohol dependence. So the focus of the therapy there needs to be on
recognition of the impairment that their alcohol dependence is producing in
their life and also focusing on either abstinence or a return to a much less
hazardous level of drinking."
As for individuals with chronic severe alcohol dependence, "We would
certainly assume that they are going to need substantial treatment,"
said Moss. "They might benefit from therapies that are directed toward
relapse prevention." Furthermore, this group is going to have
substantial psychiatric comorbidity, he pointed out, "so we have to
simultaneously address their alcoholuse disorder as well as manage their
Charles O'Brien, M.D., Ph.D., a professor of psychiatry at the University
of Pennsylvania, who was unaffiliated with the study, told Psychiatric
News that this study marks an important step in subcategorizing
alcoholism because it includes a community sample rather than simply examining
the 25 percent who present for treatment; it is based on a large dataset, and
the five subtypes seem quite recognizable based on the data used: family
history, age of onset, and presence of other psychiatric
"The next step," he said, "[is to identify] biomarkers
for even more precise subcategories, such as genotype or biochemical
An abstract of "Subtypes of Alcohol Dependence in a Nationally
Representative Sample" can be accessed at<www.sciencedirect.com/science/journal/03768716>
by clicking on "Articles in Press." ▪