in our sample with repeated binge-drinking exposures in early adulthood remains unknown. Unfortunately, for ethical reasons, alcohol challenge cannot be conducted in the United States in persons under age 21 to address this issue. Third, participants’ actual in vivo alcohol responses may differ from those measured in the laboratory and differ depending on the dose. Environmental and contextual effects are known to affect alcohol responses (54–59) but such effects were minimized in our well-controlled laboratory environment, and our dose was chosen as an alcohol challenge to reach the limit for impaired driving in the United States. Finally, consistent with DSM-5, a dimensional approach of AUD symptom count was the primary outcome. However, it was based on the 11 DSM-IV criteria for AA and AD; this differs slightly from DSM-5, which replaces alcohol-related legal problems with an item for craving, which was not ascertained in this study (60). Further, developmental diagnoses (i.e., conduct disorder or attention-deficit disorder) that may relate to drinking propensity (61,62) were not ascertained.
