What Are the Types of Alcoholism and How Severe Can It Be? What Science Says and How It Is Diagnosed

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The types of alcoholism are classifications that group people with alcohol problems according to traits such as age of onset, family history, or drinking pattern. The best known are those of Jellinek, Cloninger, Babor, and the US National Institute on Alcohol Abuse and Alcoholism (NIAAA), and none of them is used for diagnosis, because the DSM-5 classifies the disorder by criteria and degrees of severity and the WHO’s ICD-11 does so by categories.

The degrees of alcoholism have nothing to do with the strength of the drink. They refer to the severity of the disorder, which the DSM-5 divides into mild, moderate, and severe depending on how many criteria are met.

What are the types of alcoholism according to Jellinek?

In 1960, in his book The Disease Concept of Alcoholism, physiologist Elvin Morton Jellinek proposed five types, which he named with Greek letters. Thomas Babor’s review for the NIAAA summarizes each of them as follows (Babor, 1996, Alcohol Health and Research World).

The alpha type drinks deliberately and without discipline, with high psychological vulnerability, little loss of control, and a dependence that is only psychological. The beta type has no dependence and suffers high physical and mental harm.

The gamma type combines physical and psychological dependence, with great loss of control, a marked progression, and high social and economic harm. In the delta type, social and cultural factors weigh heavily, and the defining feature is the inability to abstain, with a slow progression.

The epsilon type corresponds to episodic drinking, the old dipsomania, and Jellinek described it only briefly because he believed too little was known about it. He considered only the gamma and delta types to be diseases.

The same review notes that it is usually regarded as the first scientific typology and points out that it stimulated little empirical research. It never translated into a diagnostic test or into different treatments for each type.

Cloninger’s type I and type II

Psychiatrist Robert Cloninger studied 862 men adopted in Sweden to separate the weight of heredity from that of environment (Cloninger, Bohman and Sigvardsson, 1981, Archives of General Psychiatry), and his team repeated the analysis with 913 women (Bohman, Sigvardsson and Cloninger, 1981, Archives of General Psychiatry). That work already distinguished two forms of alcoholism, and in 1987 he linked them to personality traits in the journal Science.

Type I, called milieu-limited, appears in men and women after age 25 and depends on both heredity and environment. It is associated with binge drinking, loss of control, and feelings of guilt, and with anxious people who drink to relieve tension.

Type II, called male-limited, occurs mainly in the sons of alcoholic fathers, begins before age 25, and depends more on heredity than on environment. It is associated with the inability to abstain, fights, arrests, and a personality that seeks novelty and euphoria (Cloninger, Sigvardsson and Bohman, 1996, Alcohol Health and Research World).

The authors themselves present the two types as the extremes of a continuum, not as separate diseases. A later evaluation found that the typology did not reliably separate two groups and that type II was associated, as expected, with more symptoms of antisocial disorder and more sensation seeking (Sannibale and Hall, 1998, Addiction).

Babor’s type A and type B

In 1992, Thomas Babor’s team analyzed 17 characteristics of 321 men and women with alcoholism and found two groups (Babor et al., 1992, Archives of General Psychiatry).

Type A begins problem drinking later and has few childhood risk factors, less severe dependence, and fewer psychological problems. Type B combines a family history, childhood conduct problems, early onset, more severe dependence, use of other drugs, and a more chronic treatment history.

In the original sample, 53% of the men and 38% of the women were classified as type B, and the typology was replicated in other studies (Del Boca and Hesselbrock, 1996, Alcohol Health and Research World).

What are the five NIAAA subtypes?

The most recent of these four classifications came from a national survey in the United States. NIAAA researchers analyzed 1,484 people with alcohol dependence and found five subtypes (Moss, Chen and Yi, 2007, Drug and Alcohol Dependence).

Data from Moss, Chen and Yi (2007), sample from the NESARC survey in the United States. The age at onset for the chronic severe subtype is approximate in the study.

The most common subtype is the young adult, who becomes dependent on alcohol around age 20 and almost never seeks help. The chronic severe subtype is the least common and the one that seeks treatment the most, and in this subtype and the young antisocial one about half have antisocial personality disorder.

The difference in help seeking between the two extremes is large.

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A person in the chronic severe subtype is about 7.6 times more likely to have ever sought help than a person in the young adult subtype.

What is a functional alcoholic?

A functional alcoholic is not a diagnosis in the DSM-5 or the ICD-11. The term with scientific backing is the NIAAA’s functional subtype, which accounts for 19.4% of the people with dependence in the 2007 study.

They are people with an average age of about 41 who started drinking around age 18 and developed dependence around age 37. Half are married, 62.3% work full time, and they have the highest incomes of the five subtypes.

Only 17% have ever sought help, and about a quarter have had major depression at some point in their lives (Moss, Chen and Yi, 2007). Keeping their job and family does not mean that their drinking is not harming them.

What are the degrees of alcoholism?

The DSM-5, the diagnostic manual used by psychiatrists, lists 11 criteria for alcohol use disorder (AUD), all referring to the past year. With 2 or 3 criteria the disorder is mild, with 4 or 5 it is moderate, and with 6 or more it is severe (NIAAA, 2025).

The criteria include drinking more than intended, being unable to cut down, feeling a strong craving, needing more to feel the effect, and experiencing withdrawal when stopping. The guide on how to stop drinking beer gives examples of these criteria and covers the WHO’s AUDIT test and the risks of quitting suddenly.

How does the WHO classify alcoholism?

The WHO’s International Classification of Diseases, in its eleventh revision (ICD-11), distinguishes a single episode of harmful use, a harmful pattern of use, and alcohol dependence. Hazardous drinking is left out of the disorders and is classed as a risk factor (Saunders et al., 2019, Alcoholism, Clinical and Experimental Research).

Based on 2016 data, the WHO estimates that 1.5% of the population aged 15 or older in Spain and 2.3% in Mexico had an alcohol use disorder in the past 12 months (WHO, Global Health Observatory). Dependence, the most severe form, affected 0.7% in Spain and 1.3% in Mexico (WHO).

Are the types of alcoholism of any use?

A review published in Addiction concluded that studies agree on up to four groups (chronic severe, depressed and anxious, mildly affected, and antisocial) and that few have been validated over the long term (Hesselbrock and Hesselbrock, 2006, Addiction). The authors see typologies as a potentially valuable tool for researching the causes, treatments, and course of the disorder.

Other researchers consider them potentially useful for choosing treatments and designing clinical trials, and call for unifying them (Leggio et al., 2009, Neuropsychology Review). In clinical practice, diagnosis is made using DSM-5 or ICD-11 criteria.

The labels that circulate online, such as the seven types of alcoholics, the social drinker, or the weekend drinker, do not appear in these scientific classifications. If you are worried about your drinking or that of someone close to you, in Mexico the Línea de la Vida helpline answers free of charge at 800 911 2000, 24 hours a day, and in Spain you can start with your primary care doctor.

If there is dependence, seek medical help before giving up alcohol, because withdrawal can be life-threatening (NIAAA). If seizures or hallucinations occur, call 911 in Mexico or 112 in Spain.

Frequently Asked Questions (FAQ)

1. What are the types of alcoholism?

The best-known classifications are Jellinek’s, with the alpha, beta, gamma, delta, and epsilon types; Cloninger’s, with types I and II; Babor’s, with types A and B; and the five NIAAA subtypes. None of them is used for diagnosis, because the DSM-5 classifies by criteria and degrees of severity and the ICD-11 by categories.

2. What are the degrees of alcoholism?

According to the DSM-5, alcohol use disorder is mild with 2 or 3 of its 11 criteria, moderate with 4 or 5, and severe with 6 or more. The degrees measure the severity of the disorder, not the strength of the drink.

3. What is the most common type of alcoholism?

In the 2007 NIAAA study, the most common subtype was the young adult, with 31.5% of people with dependence. They develop dependence around age 20, and only 8.7% have ever sought help.

4. What is a functional alcoholic?

It is not a diagnosis, and it corresponds to the NIAAA’s functional subtype, 19.4% of people with dependence. They are middle-aged adults, half of them married and 62.3% employed full time, and only 17% have sought help.

5. Is alcoholism a disease?

The DSM-5 classifies it as alcohol use disorder with degrees of severity, and the ICD-11 includes dependence and the harmful pattern of use among its disorders. Jellinek already considered the gamma and delta types to be diseases in 1960.

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