Importantly, there was little support for tolerance in terms of a comprehensive subjective phenomenon(8) in the progression of AUD, as “markedly diminished effects at the same amount of alcohol” was not evident in heavy drinkers as a group, or in the subgroup showing the high AUD trajectory over time. Rather, initially heavy drinkers with fewer AUD symptoms over time showed tolerance in alcohol stimulation at re-testing. Whether this change was the cause or result of their less intensive bingeing over time, or an associated feature unrelated to their drinking course, remains to be determined. Nonetheless, if tolerance were the key mechanism in the progression of AUD, reduced levels of stimulation in those with greater AUD symptoms in the interim would have been observed.
