People who consume alcohol vary quite a bit in the ways that they use it. If two people are problem drinkers, the way they abuse alcohol can be vastly different. In fact, there are two types of alcoholics, those with Type 1 alcoholism and those with Type 2 alcoholism. In the next sections, we’ll introduce you to these two clinically defined manifestations of alcoholism and the characteristics that describe them.
What Is the Premise of the Type 1, Type 2 System?
Why the need to differentiate between two types of alcoholism? For one thing, knowing the differences is crucial to identify different kinds of alcohol use for treatment purposes. It would be impossible to create an effective treatment plan for an individual with alcoholism without knowing which type of alcoholism they have.
A 1996 study on the classification of alcoholics noted that classifying people into types is a part of human nature. Types are organized in a system defined by rules, along with practical applications. Alcoholics aren’t a unified group but vary according to many characteristics, such as alcohol dependence type, drinking patterns, genetics, pre-existing mental health disorders, and personality traits. For the past 150 years, said researchers, alcohol typologies through the use of clinical subtyping, diagnostic classification, and medical nomenclature to organize clinical information have led to advancements in both clinical knowledge and the “art of healing.”
A study in Sweden in 1987 was the first to classify alcoholics as either Type 1 or Type 2, describing in detail alcoholism’s neurogenetic adaptive mechanisms. The typology developed from findings of adoptees and their adoptive and biological parents.
Type 1 alcoholism develops in adulthood. It is characterized by binge drinking that’s interspersed with lengthy periods of sobriety (abstinence). With Type 1 alcoholism, users experience a loss of control over their drinking and feel excessively guilty about their drinking. They often progress rapidly from abuse of alcohol that’s mild to severe, sometimes resulting in developing alcoholic liver disease.
Type 1 alcoholism affects men and women, although the predisposition for this type of alcoholism requires a specific genetic background to be present, along with certain environmental factors.
Personality Characteristics of Type 1 Alcoholism
Individuals with Type 1 alcoholism have high harm avoidance, which means they are more cautious, apprehensive, and inhibited toward their use of alcohol. Their personality traits include diligence to detail, reflection, and rigidness.
Type 1 alcoholics also display high reward dependence. This means that they are typically affected by and sensitive to social cues, and are eager to be of help to others, while also being sentimental and emotionally dependent.
What is a Type 2?
Type 2 alcoholism, in contrast to Type 1 alcoholism, usually occurs during adolescence or in the early adult years. Between these two types of alcoholics, those with Type 2 alcoholism frequently have skirmishes with the law, experiencing episodes of fighting and arrests. Their abuse of alcohol is typically moderately severe, requiring treatment. Unlike Type 1 alcoholism, however, the severity of alcohol abuse in those with Type 2 alcoholism doesn’t change over time.
Type 2 alcoholism more commonly occurs in men than women. A genetic predisposition is required, and environmental factors play much less of a role in the development of Type 2 alcoholism.
Typically, this type of alcoholism starts before the age of 25 (early onset). Alcohol abuse and criminal behavior, along with an inability to control their drinking or be abstinent from alcohol are strong associations with Type 2 alcoholism.
Personality Characteristics of Type 2 Alcoholism
Of the two types of alcoholics, those with Type 2 alcoholism exhibit high levels of novelty seeking. They are easily distracted, impulsive, and exploratory. Their strong motivation to drink is to experience euphoria. The constant desire to get high may lead to the use and abuse or addiction to other types of drugs.
Those with Type 2 alcoholism display low harm avoidance, meaning they’re uninhibited, optimistic, relaxed, and confident with their alcohol use.
Type 2 alcoholics display low reward dependence. They are tough-minded in social situations, detached, and practical, and show emotional coolness.
Some research shows that the traits of low harm avoidance, high novelty seeking, and low reward dependence characterizing Type 2 alcoholics are similar to the traits of those with an antisocial personality disorder. It’s no surprise, then, that many Type 2 alcoholics are also diagnosed with an antisocial personality disorder. Type 2 alcoholics also tend to dabble in other substances.
What Are the Benefits of a System Like This?
Having a system and perspective that classifies alcoholism into Type 1 alcoholism and Type 2 alcoholism can simplify the development of a treatment plan. Employing therapies known to increase self-confidence and lower anxiety, or behavioral therapies that are proven to curb impulsivity, aggression, and risk-taking are easier to determine when there’s a system in place to make the management of a treatment plan more effective.
Some individuals have a better substance use disorder treatment outcome using pharmacological approaches. Some studies found that a person diagnosed with alcohol dependence who has a specific receptor gene may be more responsive to treatment with naltrexone than those who lack this specific gene. Medication-assisted treatment (MAT) is often a key part of an effective substance use disorder treatment plan.
What Are the Shortcomings?
Type 1 alcoholism and Type 2 alcoholism are but two distinct aspects of alcoholism that exist along a spectrum. There are subsets in between that should be taken into account. The genetic backgrounds of people with alcoholism shouldn’t be expected to be the same in those with mild or severe abuse of alcohol, while the genetic backgrounds of those with moderate abuse of alcohol differ.
In a 2014 study by Wennberg et al. seeing to validate Cloninger’s Type 1 and Type 2 typology of alcoholism in a group of alcohol-dependent, yet socially stable, men and women, researchers found under a third could be classified using the typology. Authors suggested that alcoholism typologies must be clinically relevant to be valuable as an intellectual tool. They said their future research would look at other alcohol typologies and their clinical relevance in treatment outcomes.
Furthermore, alcoholism changes personality. For some alcoholics who’ve been excessive drinkers for years, it’s a difficult path to embrace sobriety. They may find it extraordinarily challenging and suffer frequent relapses or give up the goal of sobriety completely. Others, whose drinking is only more recently affecting their lives to a significant degree, may be less affected by the stigma that surrounds the fact that alcoholism changes personality.
Classifications, while useful for diagnosis, don’t always serve the individual well for their long-term recovery goals. It’s more beneficial to focus on the goals for recovery and acquire the tools, skills, and strategies that help facilitate long-term recovery.
How Each User Still Needs a Unique Treatment Plan
Everyone is different. Even with similar environmental backgrounds and certain genetic predispositions, what works best for one individual with alcoholism may not be the optimum protocol for someone else. That’s why ongoing treatment management is crucial. As individuals become more self-confident in their abilities to identify and cope with triggers and urges, for example, or learn effective techniques to manage depression, anxiety, and other emotional distress often associated with alcoholism the treatment plan needs to change to better address current needs.
It is often said that there’s no one-size-fits-all treatment plan for alcohol addiction. Each person is unique and needs a plan that’s personalized and customized to their individual needs. So, while there are many ways to categorize alcoholism, the best treatment outcomes stem from a plan that’s created purposefully for them and evolves and respects their needs, goals, and progress every step of the way.
To gain some clarity about what treatment may be best for you or a loved one with alcoholism contact FHE Health. We’re always available to answer your questions, so you can get on with your life knowing you’ve got compassionate, caring experts who can help.