Alcohol use disorder is phenotypically complex (41) and a better understanding of factors that increase vulnerability to sustained excessive drinking are crucial for effective prevention, early intervention, and treatment development (42). The current study provided the first repeated assessment of acute alcohol responses in the same people over a substantial 10-year period of adulthood. Results comprise two main findings: a) heightened sensitivity to the pleasurable effects of alcohol (stimulation, liking, and wanting) in young adulthood preceded the development of AUD through middle age; b) sensitivity to alcohol stimulation and wanting increased in repeat testing over a decade in persons developing AUD. Trajectory analyses of AUD symptom progression over follow-up confirmed these findings by demonstrating amplification of alcohol stimulation and wanting as a function of AUD severity over a decade. Notably, physiological responses such as heart rate and cortisol did not predict AUD development. Taken together, these findings support the idea that the positive stimulating and motivating effects of alcohol increase during the development and maintenance of AUD. The findings do not support the idea that low sensitivity to alcohol increases
