Collectively, these processes then define an internalizing pathway that emerges at birth and continues, given supportive risk mechanisms, into adulthood. The markers of progression along this pathway emphasize internalizing and affect regulation processes as related, eventually, to SUDs. The manner in which progression occurs along this pathway is then characterized by three concepts from developmental psychopathology. First, many of these risk processes are expected to be bi-directional. For example, increasing experience with alcohol may bolster coping motives in adolescence, particularly for COAs who show greater tension reduction benefits from alcohol as compared to their peers (Sher & Levenson, 1982). The resulting increase in substance use in turn increases negative mood (Hussong, Hicks, Levy, & Curran, 2001), elevating risk for substance-induced depression and both pharmacological (e.g., via withdrawal symptoms) and non-pharmacological influences (e.g., through coping with secondary stressors that are the consequences of use) on affect disturbance (Sher et al., 2007).
