Second, epidemiological data suggest limitations to relying on the externalizing model alone to capture developmental pathways for SUDs. For instance, in the National Epidemiological Study of Alcohol and Related Conditions, approximately 12% of adults meeting criteria for an AUD and 28% of those doing so for a drug use disorder in the past 12-months evidenced antisocial personality disorder, a predicted outcome of long-term deviant behavior associated with the externalizing pathway (Grant, Stinson, Dawson, Chou, Ruan et al., 2006). This represents a 5–12 fold increase in the odds of having an antisocial personality disorder among those with, versus without, a SUD. Nonetheless, less than a third of adults with a SUD show the expected pattern of comorbidity associated with the externalizing pathway. Other developmental pathways are clearly needed to understand additional trajectories leading to substance involvement and disorder.
