What Are the 5 Types of Drinkers?

A college student spends weekend after weekend throwing back jello shots and frat party punch. A grad student at the university does the same and has to drop out, spending the rest of the year in rehab. A mother sips wine out of a juice bottle after a PTA meeting. A teenager sneaks sips of vodka out of her parents’ liquor cabinet. The homeless man on the sidewalk clutches a beer can in a paper bag.

Who is an “alcoholic”? Although you might be tempted to say, “It’s the last one,” it could easily be all five. Alcohol use disorder (AUD) doesn’t discriminate and comes in many forms, some of which can be harder to recognize than others. Let’s take a closer look at different types of alcoholism and how they lead to five distinct types of drinkers.

What Is AUD?

First things first: we have to know what we’re dealing with. AUD is a medical condition characterized by an inability to stop or control alcohol use despite adverse consequences. As far as the science of AUD is concerned, it’s all about the brain: alcohol changes our neurochemistry in ways that can lead to misuse and, eventually, dependence. (For a deep dive, check out “Alcohol Misuse vs. Dependence: What's the Difference?”)

Over the years, there’s been much debate about the causes of AUD. Is it a habit? Is it a disease, and if so, is it genetic? Or is our environment at play? While answers remain murky, it’s clear that all of these factors can play a role. What starts out as a habit can morph into physical dependence, and certain genetic and social factors can set the process in motion.

What’s clear, though, is that there are certain hallmark characteristics of AUD:

• We have trouble cutting back on drinking even though we try to.
• We keep drinking despite the toll it’s taking on our health or relationships.
• We find ourselves drinking more than we planned to on a regular basis.
• We have cravings — a strong desire for alcohol — and spend a good part of our day thinking about it.
• We might develop withdrawal symptoms if we suddenly stop drinking.

Now that we have an idea of what AUD is, let’s take a deeper look at the five typical forms it tends to take.

The 5 Types of Drinkers

While AUD has many common features, research by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has pinpointed five different types of drinkers, each with unique characteristics and needs. As NIAAA Director Ting-Kai Li explains, 

“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.”

Let’s take a closer look!

1. Young Adult Type: Jason’s College Years

We’ll start with that college student — let’s call him Jason — who is finally on his own sharing a freshman dorm room with three other guys who, just like him, work hard during the week and play hard on the weekend. Only Jason’s week starts to become more and more weekend-heavy: there’s a beer and pizza special at the local bar on Thursdays (and no, they don’t check IDs), then weekly parties at the dance club on Wednesdays.

He pulls it off without a problem, making it all the way to senior year and graduating with honors. When it’s exam time, Jason is at the library studying. When his parents visit, he cleans up the beer cans from the counter, shoves the tequila bottle under his bed, and throws his wine-stained T-shirt in the hamper. It doesn’t cross his mind that anything is amiss — it’s college, after all! The best years of your life, right? 

Except that for Jason, the party doesn’t stop well into his 20s. His friends are settling down, some are even having kids. But Jason doesn’t feel like slowing down — hey, we’re still young! Why not keep the fun times going?

According to the NIAAA, Jason is one of the many young adults who make up the most common types of drinkers — around 31.5%. They’re rarely daily drinkers, but when they do drink, they often consume alcohol in large quantities — what many refer to as "binge drinking." 

These habits, in turn, can stick around and have long-lasting effects later in life. Booze can become a go-to way to manage stress, social anxiety, or the pressures of life as a young professional. With lines between problematic and social drinking frequently blurred in our 20s and early 30s, it can be hard to spot the problem before it progresses into the more severe stages of AUD.

Neuroscience Insights

There’s neuroscience behind the reasons why young people are especially susceptible to unhealthy drinking that progresses to AUD:

• The brain is still developing. With the brain continuing to mature until our mid-20s, the prefrontal cortex is still “under construction.” As a result, we tend to be more impulsive and likely to make rash decisions. Alcohol, in turn, can throw a wrench into the system by interfering with the prefrontal cortex and making the situation worse.
• The reward system is easily activated. Young adults have highly active reward systems, and alcohol can stoke the fire, triggering dopamine release at unnatural levels. As a result, we start looking at booze as a quick way to boost our mood or feel better amidst the inevitable ups and downs of young adulthood. 


A Way Out

Jason struggled with alcohol use throughout his 20s, but found that AA and inpatient treatment wasn’t for him. Instead, he decided to dive into books on recovery. He continued on his journey with the Reframe app and found that its community of others who could sympathize especially helpful.

2. Young Antisocial Subtype: Sarah’s Struggles

Sarah, a grad student in her late 20s, had a hard childhood. Her parents fought from the time she was a baby, exposing her to screaming matches and, later on, a bitter custody battle. As a result, she had trouble forming attachments and began showing traits of Conduct Disorder, even spending some time in juvenile detention after shoplifting makeup from a local pharmacy. As she grew up, she continued having trouble with relationships and started developing signs of Antisocial Personality Disorder.

Throughout this time, alcohol became a frequent companion for Sarah, who falls into the “young antisocial” type of AUD (about 21% of all cases). With booze freely available at home (her parents closed their eyes to the problem, if they even noticed it), Sarah developed a drinking habit in her teens. By the time she started her grad school career, she had all the hallmark signs of AUD and ended up at the emergency room after getting alcohol poisoning several times. She would start her day drinking a six-pack of hard apple cider just to stop the shakes, then attend her sociology lectures with wine in her coffee mug. 

Neuroscience Insights

Neurological hallmarks of antisocial personality (ASP) make AUD more likely:

• ASP often comes with impulse control difficulties. The prefrontal cortex, which helps regulate impulses and plan ahead, tends to be impaired in folks with ASP traits. As a result, they’re more likely to make impulsive choices or engage in risky behaviors. 
• ASP and related psychological issues lead to difficulty processing emotions. Those struggling with anxiety, depression, and other psychological conditions that often go hand-in-hand with ASP tend to have functional difficulties with the amygdala, a part of the brain involved in processing emotions. As a result, booze might seem like a quick and easy solution. 

A Way Out

Eventually, Sarah had to drop out of the program and face her demons by going through inpatient treatment at a dual-diagnosis center. Still, it took years — the overlapping challenges of ASP and social anxiety made the already rough process even lengthier. She’s been working with a Reframe coach who specializes in trauma to help and encourage her along the way. 

3. Functional Subtype: Samantha’s Secret

Samantha has it together. At just 32 years old, she’s the vice president of her publishing company, mother of two, and an active member of her school’s PTA. She has tons of friends, many of them other moms who get together frequently at her immaculate house with its manicured lawn and perfectly groomed labradoodles (adorable!). And yes, when her friends are over, there’s an obligatory bottle of wine (or three) on the coffee table. “Mommy juice, anyone?” Her husband even got her a T-shirt that says, “Kids in bed. House looks fine. Time for Mommy to drink some wine!”

And while to the outside world it looks like Samantha is on top of the world, she has a secret. Her wine habit has gotten out of control — way out of control. Like other “functional alcoholics” (which make up about 19.5% of the total), she seems to be handling her life well. However, she’s now drinking on a daily basis, starting earlier and earlier. At one point, she even started pouring wine into an empty juice bottle and taking sips during her PTA meeting. Embarrassing, yes. But not as embarrassing as being caught with her hands shaking as she’s passing out the flyers. 

And while she’s still running every morning, she’s been noticing that her body is starting to stage a revolt: her lung capacity isn’t quite as high, her muscles ache, and her blood pressure has gotten higher. Maybe it’s all the stress? No, she knows it’s probably the booze. But she feels stuck, clinging on to the very thing that’s fueling her stress in an attempt to find relief.

Neuroscience Insights

From a neuroscience perspective, functional drinkers share certain traits: 

• Their compensatory mechanisms tend to be highly adaptable. The brain is flexible, and, in a functional alcoholic, it tends to adapt in ways that are almost mind-boggling to an outside observer. Their system has adapted to the presence of booze, compensating for the impairments to cognition that would leave many others disoriented and incoherent (let alone ready to run PTA gatherings or company meetings). 
• They tend to experience cognitive dissonance. At the same time, this adaptability comes at a heavy price. It’s impossible to be in two places at once physically. In a similar way, it’s difficult to be “of two minds” when it comes to our authentic beliefs — trying to reconcile opposite viewpoints leads to a painful state known as cognitive dissonance. The functional alcoholic, in turn, is aware of their problem yet trying to be oblivious to it at the same time. This push-and-pull is difficult to sustain. What often happens is the opposite of a solution: they end up drinking more to cope with the compounding stress. They’re aware of the dangers of excessive drinking, yet they continue to drink heavily. This conflict can lead to stress, which in turn might be relieved by further drinking.

A Way Out

After a friend confided in her about having the same problem, Sarah found a women’s support group that helped her get on track. Free from the prison of cognitive dissonance, she’s doing better than ever in her job and as a parent. And her body is breathing a sign of relief — in fact, she’s training for a marathon in a few months! Reframe is helping her stay on track, and she especially enjoys the community forum and monthly challenges.

4. Intermediate Familial Subtype: Fran’s Family

Drinking has been the norm in Fran’s family. It fueled the fights between her parents for as long as she can remember, led her grandfather to develop diabetes, and kept her brother from completing his senior year of high school. That said, nobody treats it as the root of the problem — wine flows freely at family gatherings, while the fights, illnesses, and poor choices are blamed on anything but the booze. Stressful jobs, a sweet tooth, and plain old laziness — there’s always an explanation for the problem. 

And so Fran doesn’t think twice about it. After all, she hasn’t lost a job or a husband. She’s still in school (and, on top of that, is the star of her volleyball team). She still thinks of alcohol as a crucial ingredient for having fun (“This restaurant doesn’t serve booze, so why bother going?”)

The “intermediate familial” subtype is common, making up about 19% of different types of alcoholism. Unfortunately, excessive drinking is “familiar” in both senses: it’s Fran’s go-to habit, and it literally “runs in the family.” Genetics and environment play a big role here, joining forces in a way that leaves us feeling helpless and stuck. (But rest assured, there’s hope! More on that later.)

Neuroscience Insights

Biology looms large in the case of the intermediate familial subtype:

• Genetics are most likely at play to some degree. According to research, there are genetic differences in how the brain processes dopamine. The result? For some folks, external sources of the reward neurochemical feel more enticing. At the same time, genetic differences can make withdrawal worse, perpetuating the behavior. 
• The environment plays a role in conditioning behaviors around booze. Just as (if not more) important as the genetic component, environmental factors play a crucial part in keeping the cycle in motion. The brain loves patterns and has trouble breaking them once they set in. Associations between booze and “fun” condition us to see alcohol as a crutch and a source of joy. Unfortunately, both are illusions that make the pattern harder to break.


A Way Out

After Fran came across a memoir written by someone with a similar type of experience and family background, something clicked. She realized she was going down the same path as many of her relatives, but also realized that she had a choice to take a different approach. So she did! Now she’s happily alcohol-free and enjoys checking out the Reframe app readings about the latest neuroscience research on the role that genetics and environment play in alcohol misuse.

5. Chronic Severe Subtype: Tommy’s Trouble 

And finally, there’s Tommy. Unlike the previous four, Tommy has no doubt that he has a problem — and neither does anyone else who runs into him sitting on the sidewalk with his “hidden” (but ever-so-obvious) bottle. He’s been to rehab more times than he can remember, has been warned about his dangerously high liver enzyme levels, and has even woken up in jail a few times for reasons he can’t remember no matter how hard he tries. He has also struggled with intrusive thoughts but doesn’t take the meds for schizophrenia that helped him at one point, about a decade ago.

And yet, his “chronic severe” subtype of alcoholism is actually the most rare, making up only 9% of the total. Chronic severe drinkers are likely to struggle with other psychiatric conditions, such as depression, schizophrenia, bipolar disorder, anxiety, and other substance misuse problems. Unlike many of the other types of drinkers, they’re the most likely to seek help (which makes sense, given that the red flags are hard to miss). However, in spite of the fact that about two thirds seek treatment, the profound effects of alcohol can keep them trapped, leading to multiple attempts at recovery.

Neuroscience Insights

There are large-scale (and often devastating) changes that happen in the brain when we drink chronically for a long time:

• Neurodegeneration looms large. Long-term alcohol consumption can lead to neurodegeneration, damaging areas in charge of cognition, memory, and impulse control. Over time, there’s even a risk of permanent damage, known as Wernicke-Korsakoff syndrome. 
• Neurotransmitter systems get disrupted. Heavy alcohol use causes changes in our levels of dopamine, serotonin, and GABA (an inhibitory neurotransmitter). After the brain adjusts to the “new normal,” it becomes less efficient at handling stress, fostering well-being, or “sparking joy.” The result? Increased tolerance, cravings, and intense withdrawal symptoms if alcohol is suddenly removed.


A Way Out

Tommy’s road took a couple of years of trial and error, but once he found the right treatment team who addressed all of his mental health challenges along with his AUD (for which he ultimately found helpful medication), he found a way out. Once he did, he became really active in helping others, including those he met in the Reframe community.

Seeking Help for Different Types of Alcoholism

While AUD is a major challenge, it’s crucial to keep in mind that recovery is possible. Yes, all five of our characters (even Tommy) can get better! If you think you might be in the same (or similar) boat, here are some places to start.

• Be honest with yourself. The first step is taking an honest look at the situation. Don’t judge yourself for being where you are right now. Simply deciding that you’re ready to make some changes is something to celebrate. You’re on your way!
• Choose a strategy. If you’ve been drinking heavily for a long time, you might need some medical supervision in the initial stages. Don’t worry about the amount of time this might take — what’s a few days (or even a few weeks) compared to the rest of your life? 
• Pick your team. As soon as you start your alcohol journey, you’ll need a solid support system at your side. Ask your friends, family, and members of supportive online communities (such as Reframe!) for help, and let them know exactly what that entails. Maybe you need someone to give you a ride to therapy sessions or group meetings. Maybe that work happy hour will be less intimidating with a trusted friend to keep you company. Whatever it is, there are people who’ve experienced it before and will be happy to help.
• Take care of your body. Nourishing your body and replenishing the nutrients lost through alcohol misuse is key. Stick to a healthy diet and add mindful movement for some bonus points!
• Share your story. Last but not least, overcoming alcohol misuse is ultimately a personal journey, but it’s sure to resonate with others who’ve been there before or are going through it now. Your story — just like the stories of the five characters we followed — can offer valuable insights and help others along the way.

And remember, Reframe is here to help you every step of the way! The journey might seem daunting at first, but we have already helped millions of people just like you change their relationship with alcohol and go on to be the healthiest and happiest versions of themselves. It’s absolutely possible!