Who Is an "Alcoholic"?

A college student downs jello shots at weekend frat parties. A graduate student drinks heavily and eventually drops out, spending the next year in rehab. A mother sips wine from a juice bottle after a PTA meeting. A teenager sneaks vodka from her parents' liquor cabinet. A homeless man holds a beer can wrapped in a paper bag.

Which of these people is an "alcoholic"? You might be tempted to point to the last one, but the truth is, it could be any of them. Alcohol use disorder (AUD) doesn't discriminate—it appears in many forms, some more obvious than others. Let's explore the different types of AUD and how they shape five distinct drinking patterns.

What Is AUD?

First, let's define AUD. It's a medical condition where a person can't stop or control their alcohol use, even when it causes harm. Scientifically, AUD involves changes in brain chemistry that can lead to misuse and dependence.

There's ongoing debate about what causes AUD. Is it a habit? A disease? Are genetics or environment to blame? While the answers aren't simple, it's clear that all these factors can contribute. A habit can turn into physical dependence, and genetic or social influences can speed up that process.

Common signs of AUD include:

• Difficulty cutting back on drinking, even when you try
• Continuing to drink despite negative effects on health or relationships
• Regularly drinking more than intended
• Strong cravings for alcohol and spending a lot of time thinking about it
• Experiencing withdrawal symptoms when you stop drinking

The 5 Types of Drinkers

Research from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) identifies five common types of drinkers, each with unique traits and needs. As NIAAA Director Ting-Kai Li notes, "Clinicians have long recognized diverse manifestations of alcoholism... This classification system will have broad application in both clinical and research settings."

1. Young Adult Type: Jason’s Story

Meet Jason, a college student living it up with roommates who study hard and party harder. Jason starts joining weeknight bar specials and dance club parties, balancing it all until graduation. He hides his drinking from his parents and doesn't think twice about it—it's just college, right?

But the party continues into his 20s. While friends settle down, Jason keeps going. According to NIAAA, young adults like Jason make up about 31.5% of drinkers with AUD. They often binge drink rather than drink daily, but these habits can linger, turning alcohol into a coping mechanism for stress or anxiety.

Neuroscience Insights:

• The brain is still developing until the mid-20s, making young adults more impulsive.
• Alcohol interferes with the prefrontal cortex, worsening decision-making.
• Young adults have highly active reward systems, and alcohol triggers dopamine release, making it a quick mood booster.

A Way Out: Jason found that AA and inpatient treatment weren't for him. Instead, he turned to recovery books and used the Quitemate app, where a supportive community helped him stay on track.

2. Young Antisocial Subtype: Sarah’s Struggles

Sarah had a tough childhood marked by family conflict and early behavioral issues. She struggled with relationships and showed signs of antisocial personality traits. Alcohol became her constant companion, starting in her teens and escalating in grad school. She ended up in the ER multiple times for alcohol poisoning and drank daily to function.

This "young antisocial" subtype accounts for about 21% of AUD cases. People in this group often have co-occurring mental health challenges and impulse control issues.

Neuroscience Insights:

• Antisocial personality traits are linked to impaired prefrontal cortex function, leading to poor impulse control.
• Difficulty processing emotions, often tied to amygdala dysfunction, can make alcohol seem like an easy escape.

A Way Out: Sarah dropped out of grad school and entered a dual-diagnosis treatment program. She's now working with a Quitemate coach who specializes in trauma to support her recovery.

3. Functional Subtype: Samantha’s Secret

Samantha appears to have it all: a successful career, a family, and an active social life. But secretly, her wine habit has spiraled out of control. She drinks daily, sometimes hiding it in a juice bottle, and her health is starting to suffer. Functional alcoholics like Samantha make up about 19.5% of AUD cases—they maintain their lives but at a high cost.

Neuroscience Insights:

• Functional drinkers often have highly adaptable brains that compensate for alcohol's effects, allowing them to appear normal.
• They experience cognitive dissonance—knowing they have a problem but ignoring it, which increases stress and can lead to more drinking.

A Way Out: After a friend confided in her, Samantha joined a women's support group. She's now alcohol-free, training for a marathon, and uses Quitemate's community forums and challenges for ongoing support.

4. Intermediate Familial Subtype: Fran’s Family

Drinking is a family tradition for Fran. It's normalized at gatherings, and problems are blamed on everything but alcohol. Fran doesn't see her drinking as an issue—she's doing well in school and sports. This "intermediate familial" subtype makes up about 19% of AUD cases, where genetics and environment both play strong roles.

Neuroscience Insights:

• Genetic differences can affect how the brain processes dopamine and handles withdrawal.
• Environmental conditioning reinforces drinking as a source of fun or relief, creating hard-to-break patterns.

A Way Out: After reading a memoir about someone with a similar background, Fran realized she could choose a different path. She's now alcohol-free and enjoys learning from Quitemate's resources on genetics and alcohol misuse.

5. Chronic Severe Subtype: Tommy’s Trouble

Tommy's AUD is severe and obvious. He's been in rehab multiple times, has health issues, and has struggled with mental health conditions like schizophrenia. Despite being the rarest subtype (about 9% of cases), chronic severe drinkers are most likely to seek help, though recovery can be challenging.

Neuroscience Insights:

• Long-term alcohol use can cause neurodegeneration, damaging areas responsible for memory and impulse control.
• Chronic drinking disrupts neurotransmitter systems (dopamine, serotonin, GABA), leading to tolerance, cravings, and severe withdrawal.

A Way Out: With a treatment team that addressed both his mental health and AUD, Tommy found recovery. He now helps others, including through the Quitemate community.

Seeking Help for Different Types of Alcoholism

Recovery is possible for everyone, no matter which type of drinker they are. Here are some steps to start:

• Be honest with yourself: Acknowledge where you are without judgment.
• Choose a strategy: Seek medical supervision if needed, especially if you've been drinking heavily.
• Pick your team: Build a support system with friends, family, and communities like Quitemate.
• Take care of your body: Eat well, stay active, and replenish nutrients.
• Share your story: Your experience can inspire and help others on their journey.

Remember, Quitemate is here to support you every step of the way. Millions have used it to build healthier relationships with alcohol—you can too!