Despite these limitations, there are a number of strengths to our study. The sample is large, ethnically diverse, at very high risk as indicated by a majority whose parents and other relatives are affected with AUD, and in the peak age range for AUD transitions. The detailed phenotypic information permits characterization of offspring on a variety of attributes that promote transitions, and the definition of these as time-varying strengthens the inferences drawn from the hazard ratios as antecedent and not simply correlated influences. We have examined four stages in the development of AUD with the same covariates included in each model, permitting comparison of associations across early and late stages of AUD development. Overall, our findings indicate that externalizing influences were observed at all stages of AUD development, while internalizing characteristics were associated with later stages and were more potent for females with respect to problem acquisition. Findings also highlight the influence of maternal AUD in the progression of alcohol involvement, motivating further work into what may underlie such associations. Lastly, in light of the increasingly permissive legal status of
