With a combined lifetime prevalence of approximately 30%, alcohol abuse and dependence are among the most common and debilitating psychiatric disorders in the United States.1 Young adults represent a vulnerable population wherein emerging patterns of abuse particularly in response to stress2 can precipitate long-term dependence and associated negative sequelae in mental and physical health as well as achievement in academic and occupational settings.3–9 While viable treatment options are available, relatively high long-term relapse rates10 highlight the need for more effective prevention. Both treatment and prevention efforts have been hampered by substantial disorder heterogeneity, but subtyping individuals with alcohol use disorders (AUD) based on clinical presentation and overt behavioral traits has ultimately proven ineffective in improving long-term treatment efficacy.11 Defining distinct biological pathways of risk in highly vulnerable populations before the onset of disorder may contribute to novel subtyping paradigms that may yield more effective strategies for intervention and prevention.
