A schematic of the pathways that are of primary relevance to the core features of risk for alcohol dependence, particularly behavioral and affective dysfunction. The pathways are color coded to assist in visualization. The externalizing pathway to alcohol dependence (yellow) is associated with deficits in executive function and in inhibition and may share a common genetic diathesis with ADHD and conduct disorder. The brain regions of the externalizing pathway consist of the cerebellum (Crb), thalamus (Tha), and prefrontal cortex (PFC) which comprise the cerebellothalamocortical feedback system. The internalizing pathway to alcohol dependence (green) is associated with affective dysregulation (i.e. depression and anxiety-related traits), deficient mechanisms of motivation and reward (i.e. impulsivity and dysfunction in decision-making), and autonomic hyperarousal (i.e. harm avoidance and stress reactivity) through overlapping pathways of the HPA system (shown in red). The internalizing pathway includes the amygdala (Amy), orbitofrontal cortex (OFC), and hypothalamus (Hyp) and pituitary (Pit) of the HPA axis, as well as the brain regions of the mesolimbic dopamine pathway (NAc = nucleus accumbens; VTA = ventral tegmental area). The cingulate gyrus (CG) connects these pathways
