What is striking about this literature is that there is little integration with the body of research on pathways of risk for alcohol problems. Individuals use and abuse alcohol for different reasons (Heinz et al., 2003), and the development of alcohol-related problems is often discussed within the context of multiple pathways. In a study we conducted on the association between early childhood temperamental factors and adolescent alcohol use using data from >12,000 individuals followed from birth, we found two distinct temperamental/behavioral patterns evident before age 5 that predicted mid-adolescent alcohol use: (1) children who were rated as having consistent emotional and conduct problems and (2) children who were rated as consistently sociable both had elevated rates of alcohol use in adolescence (Dick et al., 2013). An externalizing pathway, characterized by behavioral undercontrol, sensation-seeking, impulsivity, and antisocial behavior, has been robustly associated with alcohol problems (Zucker, 2008), and there is more modest evidence for a risk pathway characterized by internalizing symptomatology (Zucker, 2008; Hussong et al., 2011). Further, individuals with alcoholism also show considerable heterogeneity, with a common distinction being alcoholics
