Unlike associations with externalizing, internalizing symptoms were not associated with hazards for subsequent alcohol transitions. These results diverge from prior work in COGA-P showing that the presence of any internalizing disorder is associated with time to first AUD diagnosis (Bucholz et al., 2017). Sample sizes for certain individual disorders may have resulted in underpowered analyses, or perhaps an overarching internalizing domain confers more risk than specific disorders. However, post-hoc analyses painted a more nuanced picture; suicidal ideation and social anxiety were associated with increased hazards for progression from initiation to severe—but not mild or moderate—AUD. This pattern of results is consistent with recent analyses showing that AUD criteria mapping onto the Withdrawal/Negative Affect and Preoccupation/Anticipation stages are more frequently endorsed by those with severe AUD (Miller et al., 2023) and that anxiety and depression are linked with alcohol dependence symptoms more strongly than with initiation or quantity/frequency measures (Dick et al., 2014). Suicidal ideation has been cross-sectionally linked to more severe problematic alcohol use (Crossin et al., 2022), and suicide attempt has been longitudinally linked to future DSM-IV alcohol dependence
