The study was limited by the legal requirement that participants be a minimum of 21 years old to be given alcohol, so it is unclear whether the findings can be generalized to even younger drinkers. This is particularly important because the ages of 18 to 20 years represent the highest prevalence of binge drinking and alcohol use disorders.36 Second, participants’ average age was 25 years, which for many HD corresponds to 5 to 7 years of regular binge drinking. Therefore, it was not possible to determine whether alcohol-induced responses were constitutional or acquired with repeated exposure to alcohol. This question may be best addressed using animal models. Finally, although the quarterly follow-up assessments after the laboratory sessions were sufficiently frequent to show fluctuations in drinking for 2 years, the length of this interval may not have been adequate for the full range of drinking and related alcohol use disorders to emerge. To address this issue, we plan to continue to follow up these participants to examine their drinking patterns over a longer time.
