The emergence of alcohol use disorders, as with other psychiatric disorders that follow a developmental course, are preceded by a number of neurobiological and psychosocial risk factors that are often predictive of outcome. Identified in this review are two likely pathways to the emergence of alcohol use and subsequent abuse and dependence: (1) A constellation of externalizing behaviors representative of deficits in executive control and behavioral inhibition and (2) a trajectory of internalizing problems undermined by mechanisms of affective dysregulation. Importantly, these behavioral and emotional characteristics are present before the onset of alcohol use and appear to be subserved by genetically-mediated neural circuits in the offspring of alcoholics.
