It is important to consider the diverse developmental pathways of risk whereby individuals ultimately develop an AUD because each of the pathways may be associated with alterations in varying neural circuits. A diagnosis of a disruptive behavior disorder (e.g. ADHD, conduct disorder, oppositional defiant disorder) increases the likelihood of an AUD in young adulthood among offspring with an alcoholic parent. Offspring of alcoholics also are at greater risk for developing internalizing disorders (anxiety disorders, major depressive disorder and related mood disorders) that influence the likelihood of future substance use problems. Because the neural circuitry associated with ADHD, conduct disorder, ASPD, anxiety, and depression most likely differs in structural or functional characteristics, it is important to assess comorbid conditions in offspring who are at risk for AUD because of their familial/genetic background. Uniformity of results should probably not be expected for high risk offspring unless personal histories of psychiatric disorders are controlled. However, the prefrontal cortex and regions of the limbic system are good candidate regions because they have been observed to be abnormal in individuals with externalizing and internalizing disorders and in offspring of alcoholics.
