The Classification of Alcoholics: Typology Theories From the 19th Century to the Present.

Alcoholics differ in many of their personal and drinking-related characteristics, and for the past 150 years, clinicians and researchers have tried to categorize alcoholics based on these differences. Such typologies can advance our understanding of alcoholism as well as improve treatment of the disease. The history of alcoholism typology can be divided into three periods: the prescientific period, the Jellinek era, and the post-Jellinek era. During the prescientific period, physicians-especially those specializing in treating mental illnesses and addictions-developed numerous typologies, building primarily on clinical observation, anecdotal evidence, and armchair intuition. EM. Jellinek has been credited with creating the first scientific typology that was developed into a comprehensive theory of alcoholism as a disease. The typologies that have evolved since Jellinek's landmark work have been derived mainly from empirical research data. Despite the wide variety of methodological approaches used, it appears that subtypes from all typologies developed since the 19th century can be classified into two major categories, the Apollonian and Dionysian subtypes. KEY WORDS: AOD dependence; disorder classification; Jellinek typology; historical review; AOD use pattern; personality trait; AODR (alcohol and other drug related) disorder; comorbidity; etiology; AOD associated consequences; treatment research Although alcoholism often is treated as a unitary disorder that can be described by a single disease label, ample evidence indicates that alcoholics differ in a wide variety of defining characteristics, such as drinking patterns, type of dependence, genetic predisposition, personality traits, and antecedent psychiatric disorders. Recognition of this heterogeneity has led to attempts to develop alcoholism typologies-that is, to classify groups of alcoholics according to defining characteristics-in order to better understand the etiology of alcoholism (i.e., the mechanisms leading to the disease), improve treatment, and advance the theoretical framework for alcoholism and its consequences. This article traces the clinical and scientific thinking about alcoholism typologies during the past 150 years. During this time, the history of typological thinking about alcoholics can be roughly divided into three periods: the prescientific period of clinical speculation (1850-1940), the Jellinek era of review and synthesis (1941-1960), and the post-Jellinek period of increasingly sophisticated empirical research (1960present). To the extent that ideas do not develop in a vacuum, this history provides an interesting example of how "invisible colleges" of like-minded thinkers are capable of advancing knowledge both as groups and individuals. The article also demonstrates that despite the plethora of alcoholism typologies developed over time and the variations among them, recurring traits in the drinkers' personalities appear to exist among the typologies, thereby allowing alcoholism subtypes to be separated into two major categories, the Apollonian and Dionysian subtypes. WHY IS ALCOHOLISM TYPOLOGY IMPORTANT? The urge to classify objects, ideas, and people into meaningful categories, or types, is a basic characteristic of human nature. When types are organized into a system according to definitional rules and practical applications, the classification is called a typology. Although the tendency to classify people undoubtedly serves an important medical function (e.g., knowing that a particular patient with liver disease is an alcoholic may help clinicians more effectively manage that patient's disorder), the common propensity to reduce individual differences among people to simplistic stereotypes also can distort our perceptions of social reality. Alcoholics commonly have been associated with dysfunctional stereotypes, as evidenced by the variety of pejorative terms used in different languages to describe them. For example, vagabonds and homeless people with alcohol-related problems have been referred to as "Bowery bums" and "Skid Row alcoholics. …