We also found that internalizing disorders were associated with greater risk for AUD symptom onset in females, but not males. A recent study found that the association of heavy episodic drinking with depressive symptoms was stronger in females than in males between ages 14-17, but this association disappeared once cannabis and tobacco use were included. (Schuler et al 2015). In contrast, the sex difference remained in our study after adjustment for cannabis and other covariates, a robust association that may be due to the high risk nature of the sample and attendant comorbidities of AUDs and other psychiatric disorders (Nurnberger et al 2004). Further, our findings are consistent with investigations that have identified female-predominant subtypes of alcoholism characterized by negative affect (Del Boca and Hesselbrock, 1996), and stronger associations between negative affect and alcoholism for women than for men (Kessler et al 1997). Overall, our results emphasize the role of negative affect in later AUD transitions, drawing attention to youth (and especially females) that may have been neglected in evaluations of problem drinking because they are considered to be outside the externalizing risk domain.
