The accelerated development of depression and suicidal ideation following alcohol initiation and AUD onset, coupled with the absence of the reverse relationship, may be attributed to several factors. First, initial alcohol use and escalation may increase negative affect as alcohol use becomes more compulsive and non-alcohol rewards become less reinforcing, consistent with the stage-based model (Koob, 2015; Koob & Volkow, 2010, 2016). Prior work showed that the risk of depression onset following alcohol dependence is higher than the risk of alcohol dependence following depression (Fergusson, Boden, & Horwood, 2009; Gilman & Abraham, 2001; but see Polimanti et al., 2019). Second, internalizing may be unrelated to or protective against alcohol use, depending on developmental timing and/or levels of concurrent externalizing symptoms. Internalizing has been linked with future problematic alcohol use in adulthood but not adolescence (King et al., 2020), and internalizing symptoms may confer more risk at low levels of EXT (Colder et al., 2013, 2017). Third, early initiation and development of AUD may be linked with negative social, academic, and functional outcomes that increase risk for depression and suicidality (Miller,
