Importantly, however, the similarity of analyses using different diagnostic time-frames does not speak directly to the nature of causal or temporal associations between the variables studied. Elsewhere, we have argued that the causal influences between internalizing symptoms and pathological alcohol use are bi-directional (Kushner et al., 1999; Kushner et al., 2000). However, our present study of whether alcohol dependence is related in a unique or general way to a range of internalizing disorders does not imply any necessary causal relationship between internalizing disorders and alcohol dependence. This focus and aim is consistent with our use of the cross-sectional NESARC (Wave 1) dataset. With that said, extensions of the work presented here could include more complex models that specify and test temporal/causal hypotheses. For example, the order of onset could moderate the degree to which general versus unique components of internalizing psychopathology correlate with alcohol dependence.
