Typologies of Alcohol Dependence. From Jellinek to Genetics and Beyond

Abstract

The goal of typology research is to identify subtypes of alcohol dependent (AD) patients sharing fundamental characteristics and try to match each subtype, with the most precise treatment strategy. This review provides a comprehensive history of the literature on alcohol dependent subtypes starting from the earliest attempt made by Jellinek. The binary models identified most closely with Cloninger and Babor as well as the successively more complex classifications are discussed. Typology classification potentially useful in guiding the treatment of AD patients, especially in the case of the serotonergic medications. Contrasting data suggests that other factors could influence the response to a medication and/or that more complex typologies should be identified. In summary, typology models may assist in the ascertainment criteria for clinical trials performed in behavioral and pharmacotherapeutic interventions. Greater emphasis, however, must be made to more clearly delineate this field of research, while moving toward more standardized typologies.

A possible contribution to improving the therapeutic potentials of Babor's Typology of Alcohol Dependent Patients

“…Environmental and genetic features contribute both to the pattern of alcohol consumption and to the risk of ADS 1 . Patients with alcohol related disorders (ARD) differ in many traits, such as age of onset of heavy drinking (early or late), patterns of drinking (continuous or binge), rate of alcohol metabolism, susceptibility to intoxication, presence or absence of comorbid psychiatric illness and rapidity of progression to medical problems 2 . The heterogeneity of clinical presentation of ARD -which include relevant differences according to their gender 3 -has justified efforts to classify them into subtypes that refine diagnosis and may give support to tailored treatment designs and better established prognosis [4][5][6] .…”

“…Even though Babor's binary typology of alcoholism has been repeatedly used in researches in this field, it has not yielded consistent results as far as its clinical and epidemiological usefulness, as expected of medical typologies 4,[15][16][17][18][19] . It has been suggested that future typological research should strive to identify the limitations of actual classifications, highlight their differences and explore the consistencies they might share, to move towards a more effective routine clinical use 2,20 . The objective of this study was to replicate Babor's Typology and to explore clinical features related to personality traits that may underlie this classification of ADS patients, in order to improve its therapeutic possibilities.…”

Are the binary typology models of alcoholism valid in polydrug abusers ?

“…Substance abuse typologies are used to diagnose addiction disorders, provide information regarding psychological and neurobiological mechanisms, help guide therapeutic choices, and assess the effectiveness of treatment response. [5][6][7] Two of the most important typological models of alcoholism are the classifications established by Cloninger et al 8 and Babor et al 9 Based on the genetic and environmental features of alcoholism vulnerability, Cloninger et al 8 discriminate two subtypes of alcoholism: type I and type II. In clinical terms, type I is defined by a later onset of problem drinking and fewer alcohol-related problems.…”

“…As a result, we could formulate the following research questions: Do alcoholism classification constructs remain valid in populations that present a lifetime diagnosis of alcohol dependence and a ''primary'' diagnosis of opiate or cocaine dependence? Additionally, how can we generalize the clinical findings achieved in alcoholism typologies studies 6 to these polydrug subtypes? For instance, results from psychosocial and pharmacological trials demonstrate that alcoholism subtype influences the benefit derived from specific alcoholism treatments.…”

“…3 Considering medications, we now have evidence that some alcoholic subtypes obtain superior benefit from specific psychopharmacological compounds, e.g., naltrexone in Cloninger type I, sertraline in Babor type A, and acamprosate in Cloninger type II. 6 In sum, considering the potential usefulness of alcoholism subtyping systems 22 and the current dissemination of polydrug consumption patterns among clinical substance user populations, 23 it is important to assess how the Cloninger and Babor classifications perform in other substance abuse disorders.…”