This study was the first longitudinal examination of alcohol responses measured under controlled conditions in heavy binge drinkers varying in their progression of AUD through early- to mid-adulthood. In this phase of the CSDP, we report that the heightened alcohol stimulation and reward and lower sedation and cortisol response observed in heavy versus light drinkers at initial testing (29) remained at reexamination testing 5–6 years later. Specifically, among heavy drinkers with increasing symptoms of AUD, at re-examination at a peak BrAC near 90 mg/dl, heightened stimulating and rewarding alcohol effects with lower sedative and neuroendocrine effects persisted. In contrast, heavy drinkers with few emerging symptoms of AUD (and markedly less binge drinking) showed reduced alcohol stimulation at reexamination with persistent lower alcohol reward than in heavy drinkers with either intermediate or high AUD symptoms. Light drinkers largely continued low-risk drinking and rare AUD symptoms over time with an overall protective alcohol response “footprint”: persistently low sensitivity to alcohol stimulation and reward and high sensitivity to alcohol sedative and stress hormone effects. All these aforementioned effects remained after controlling for covariates
