LR impacts on adverse alcohol outcomes both directly and through mediation by several additional characteristics. While few data are available to date on sex effects for these processes, overall it is hypothesized that: 1) people, especially during adolescence, tend to drink to obtain desired effects, such as intoxication; 2) those with low LR learn they need to consume relatively high amounts of alcohol to obtain the effects they want; 3) imbibing more alcohol per occasion in the context of a low LR contributes to selecting similar heavy drinking peers as friends [12]; 4) with repeated experience with alcohol, the low LR and the influence of heavier drinking peers alter what one expects to occur when drinking, and contributes to the belief that heavy drinking is normal behavior [13-15]; and 5) the resulting heavier drinking and associated behaviors increase life stresses which contribute to the use of alcohol to cope with stress [16]. These hypothesized relationships form the structure of the LR-based Structural Equation Models (SEMs) that have been well validated in male or combined male/female-based cross-sectional and prospective models [e.g., 6, 17-20].
