Academic journal article Alcohol Health & Research World

Type A and Type B Alcoholism

Academic journal article Alcohol Health & Research World

Type A and Type B Alcoholism

Article excerpt

Babor's classification of alcoholism uses multiple characteristics to assign subjects to two categories, called type A and type B. Type B alcoholism appears to be consistently more severe than type A. Research findings are reviewed that support the usefulness of Babor's typology for different drugs of abuse, clinical settings, gender, and race. KEY WORDS: AOD dependence; disorder classification; patient assessment; disease course; racial differences; risk factors; high risk group; treatment outcome; applied research; gender differences; patient-treatment matching

Researchers have long attempted to categorize alcoholics based on various defining characteristics, or dimensions. These attempts reflect the understanding that alcoholism is not a single disease process but a complex biopsychosocial disorder with many different causes, complicating factors, courses (i.e., expression and progression of symptoms), and outcomes. Although some alcoholism typologies have been based on a single dimension (e.g., early versus late onset), typologies involving multiple dimensions may characterize subjects more accurately while predicting a broader range of outcomes (Babor et al. 1988, 1992a).

Typological studies often use a computerized statistical technique called cluster analysis to group subjects within a population based on multiple dimensions. Dimensions relevant to alcohol and other drug (AOD) disorders^SUP1^' include factors that precede the disorder (e.g., family history, personality, childhood behavior problems, and age of onset of AOD problems), severity of symptoms (e.g., amount and frequency of AOD use), and adverse medical and psychosocial consequences of AOD use (Babor et al. 1992b).

Evidence from both treatment (Babor et al. 1992b) and adoption (Cloninger 1987) studies suggests that all subjects in any sample of alcoholics can be assigned to one of two types that differ consistently in multiple dimensions (see table 1). This article explores Babor and colleagues' twotype model.

TYPE A AND TYPE B ALCOHOLISM The typologies introduced by Babor and colleagues (1992b) and Cloninger (1987) are similar despite minor differences.^SUP2^ Both Babor's type A and Cloninger's type I alcoholism are characterized by a later age of alcoholism onset, weaker family history (i.e., fewer first-degree relatives who are alcoholics), less severe dependence, fewer symptoms of co-occurring psychiatric disorders, and less psychosocial impairment (i.e., negative familial, social, legal, or occupational consequences of drinking). Conversely, Babor's type B and Cloninger's type II refer to a more severe alcoholism, characterized by earlier onset; stronger family history; more impulsive behavior and childhood conduct problems; more severe dependence; multiple drug abuse; and co-occurring psychiatric disorders, especially antisocial personality disorder (ASPD).^SUP3^

The clinical usefulness of any typology lies, in part, in its ability to help explain the different causes, courses, prognoses, and outcomes for a disorder. In addition, a typology for AOD abusers should apply to a wide range of drugs; treatment types; and demographic dimensions, such as age, gender, socioeconomic status, and race. Based on this premise, the following sections will examine type A and type B alcoholism.

APPLICABILITY TO DRUGS OTHER THAN ALCOHOL Many AOD abusers use more than one drug. Therefore, an important issue for typological research is whether the dimensions for alcoholism types apply to other drugs as well. Researchers have found elevated rates of ASPD, depressive disorders, anxiety disorders, and multiple drug abuse among alcohol, cocaine, and opiate users (Rounsaville et al. 1982, 1991) and their first-degree relatives^SUP4^ (Mirin et al. 1991). In addition, the symptoms used to diagnose alcohol dependence seem to apply to cocaine and opiate dependence (Kosten et al. 1987). Thus, abusers of a range of drugs often share similar risk factors, symptoms, and consequences of AOD use. …

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