In summary, we propose revisions to current theories of the role of alcohol response to subsequent drinking problems in at-risk individuals, and we set forth a modified differentiator model to focus on both positive (stimulant, as well as hedonic and motivational rewarding) and sedative alcohol effects either without ties to a specific BrAC limb, or simply at peak BrAC. Heavy drinkers experience markedly different responses to alcohol than do LD. For LD, an intoxicating dose of alcohol produces tired and sluggish feelings and activates release of the stress hormone cortisol. During a 2-year interval, few of them increased their drinking. In contrast, HD showed a variety of drinking trajectories during the 2 years of follow-up, and those experiencing less positive and more sedative acute alcohol effects gradually matured out of binge drinking over time. On the other hand, HD with heightened rewarding effects of alcohol perpetuated and increased binge drinking frequency over time, thereby increasing the likelihood of meeting DSM-IV diagnoses of alcohol abuse and dependence.
