Alcoholic subtypes: are two sufficient?

Aims: Guided by the literature on alcohol subtypes, cluster analytical solutions ranging from two to five were evaluated for a large (n = 802), ethnically diverse sample of alcoholic in-patients.

Design: Personal interview data were collected from in-patients regarding their substance abuse and psychiatric disorder status, risk factors for psychopathology and health outcomes.

Setting: The data were collected at five alcohol in-patient treatment settings in New York; three settings were in New York City, one in Rochester and one in Buffalo.

Participants: The sample included 802 participants (481 males and 321 females) with racial/ethnic group diversity (418 blacks, 180 whites, 187 Hispanics, 17 of other ethnic origin).

Measurements: Subjects were assessed with standardized measures of substance abuse and psychiatric disorders, family history of alcoholism, psychopathy, temperament, alcohol expectancies and clinical health variables.

Findings: Based on internal and external criteria and compatibility with the existing literature, four subtypes were identified: mild course, polydrug, negative affect and chronic/antisocial. On external criteria, the polydrug subtype had the highest rate of family criminality, high-risk sexual behavior and intravenous drug use; the negative affect subtype had the highest rate of childhood sexual abuse, attempted suicide and childhood homelessness; the chronic/antisocial personality (ASP) subtype had the most severe pattern of drinking and antisocial behavior.

Conclusions: Findings are discussed with regard to the etiological and clinical utility of the four-subtype formulation, and consistency with recent studies in molecular genetics and pharmacology.