An internalizing pathway to alcohol use and disorder.

Research emanating from the field of developmental science indicates that initial risk factors for alcohol use and disorder can be evident in early childhood. One dominant developmental pathway connecting these initial risk factors with subsequent alcohol involvement focuses on the central role of disinhibited or externalizing behaviors. In the current paper, we delineate a second pathway that focuses on internalizing symptomatology. Several studies indicate that internalizing symptoms in early and middle childhood predict alcohol involvement in adolescence and young adulthood. We use a developmental psychopathology framework to describe a risk model that traces the potential developmental markers of this internalizing pathway and to consider the relation between the internalizing pathway and the more widely researched externalizing pathway. We outline the markers of risk in this pathway and conclude with a discussion of the implications of this model for prevention efforts and future research. In this manner, we strive for a translational goal, linking our existing understanding of internalizing processes and alcohol use and disorder with our efforts to develop effective prevention programs.