However, this is not to say that the internalizing pathway simply defines a set of risk processes that are subsumed by the externalizing model. Rather, risk processes underlying the internalizing pathway are unique in that the internalizing pathway (a) emphasizes the role of emotion-regulation within the development of self-regulation as central to early risk for SUDs, (b) defines self-medication as a central process translating deficits in self-regulation into substance-related behaviors and risk for addiction specifically, and (c) focuses on the Negative Affect form of SUDs as a salient outcome. With these emphases, the internalizing pathway defines markers of developmental progression along a trajectory identified by these three hallmarks of internalized SUDs (i.e., emotion regulation deficits in early childhood, self-medication with substance use onset typically in adolescence, and the onset of Negative Affect SUDs in early adulthood).
