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The Classification System and Understanding of Alcoholism

By: , Posted on: March 25, 2014

Behavioral Addictions
Take a peek inside Behavioral Addictions below, with Chapter 1 – An Introduction to Behavioral Addictions.

The drive to stimulate the pleasure centers trumps reason and common sense, steamrolling past regret, dismissing yesterday’s bad experiences and overriding the very instinct to survive. Surgically implant an electrode in a rat’s brain that stimulates these pleasure centers, and you’ll have a rat that will do anything and everything possible to get more and more brain stimulation. Give the rat a choice between hitting a lever to stimulate the pleasure centers or hitting a lever to feed itself and its pups and it will choose pleasure over survival nearly every time. Only death permanently separates the rat from its fix. Each of us has our poison. A personal poison that makes us feel better in a jiffy, soothes us, ignites the reward center of the brain, transforms us and offers peace of mind and a false sense of balance. It’s a poison so delectable that we erroneously convince ourselves that the benefits outweigh the risks. For some of us, it’s alcohol, drugs or cigarettes. For others, it’s compulsive sex. For many, it’s fatty foods. Few of us live without some irrational and destructive desires.

Alcohol addiction, well studied for years, is a prototype for the addictive cycle. Alcohol turns on and off major neurotransmitters in the brain and has anxiety-reducing effects. Body weight, age, and genetic metabolism all play a role in determining whether alcohol makes you sick or makes you feel great. For most of us, taking two or three drinks relaxes us — much more makes us sick. Yet, there are some people who take their first drink and a light goes off — an ease, a feeling of well-being previously unknown overtakes them.

It’s no surprise that these people tend have a predisposition to become alcoholics, people for whom the consumption of four, six, even twelve drinks, means that the party is just getting started. In the scientific literature, on average, biological (not adopted) children of alcoholics are able to consume much more alcohol than non-relatives from the moment of their very first drink, supporting the theory that biological predispositions play a major role in the development of alcoholism. To understand the biological susceptibility that some people have to alcohol, researchers break down alcoholics into Type 1 and Type 2 subgroups. Those who learn to drink in response to environmental pressures are Type 1 alcoholics. Those who drink because of an inborn, biological urge are categorized as the more severe Type 2 alcoholics.

This classification system is based on research done during the 1980s in Stockholm on children of alcoholics who were adopted and thereby, grew up without the influence of their biological parents. According to this system, Type 1 Alcoholics are essentially made, not born. They develop their disease after the age of 25, they don’t have many alcoholic relatives and therefore don’t seem to have a strong genetic predisposition. Their ‘need” for alcohol has been influenced by stressor and environmental influences. They tend to have passive personalities and succumb to peer pressure. They tend to be anxious and use alcohol to calm down. In sum, Type 1 Alcoholics get that way as a result of their environment and a temperament that makes them susceptible. They have a less serious, less entrenched and more treatable form of alcoholism.

Type 2 Alcoholics, on the other hand, have strong family histories, their problems tend to develop earlier in life (before age 25,) they tend to be antisocial (criminal and anti-authority types) and their alcoholism is far more serious (but still treatable.)  This division has its merit and most alcoholics can be placed somewhere on the continuum between those who are “made” and those who are “born.” But few alcoholics can be classified as purely Type 1 or Type 2. Increasingly, we see every behavior as the result of the complex interplay between our psychology, biology and environment. There are probably dozens of types of alcoholics, not to mention that each of the 18 million alcoholics living in America is unique.

The classification system and understanding of alcoholism has been the foundation for research into other addictions. A multitude of new studies demonstrate that  behaviors –from gambling to sex and even Internet use — can hijack the brain just like alcohol. We’re learning that substances and behaviors alike can ignite the brain’s reward system and lead vulnerable individuals into the addictive cycle. This understanding is the basis for the new research, and our new textbook, on behavioral addictions.

Tune in next month for a blog on other addictions.

For more information, take a look at this free chapter from the new book Behavioral Addictions, by Kenneth Paul Rosenberg and Laura Curtiss Feder.

You can view the chapter on ScienceDirect if you have the required access. Or, view the chapter below.

Download (PDF, 816KB)

About Kenneth Paul Rosenberg

Kenneth Paul Rosenberg, MDKenneth Paul Rosenberg, M.D., is Clinical Associate Professor of Psychiatry and Public Health at the Cornell University Medical Center – New York Presbyterian Hospital and a psychiatrist in private practice. He graduated from the Albert Einstein College of Medicine and completed his psychiatry residency and fellowship at Cornell Medical Center. Dr. Rosenberg is a contributing editor of the Journal of Sex Therapy, the author of scientific and lay articles, listed among the Best Doctors® in America and New York Magazine’s Best Doctors, a Distinguished Fellow of the American Psychiatric Association and the recipient of medical and public service awards from the American Medical Association, American Psychiatric Association and the Alliance for the Mentally Ill.


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