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Chunk #5 — The case for pursuing an internalizing pathway to SUDs

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An internalizing pathway to alcohol use and disorder.
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In models of adult alcoholism, the antisocial form of alcoholism associated with the externalizing pathway is but one of two dominant subtypes of alcoholism that is defined via patterns of comorbidity (Babor, 1996; Zucker et al., 2006). An alternate is Depressive or Negative Affect Alcoholism. The developmental pathway leading to this form of alcoholism remains poorly articulated in the literature. Several factors may underlie this lack of research attention, some of which relate to early conceptualizations of a Depressive Alcoholism subtype (Cloninger, 1987; Cloninger, Sigvardsson, Gilligan, & von Knorring, 1988; Cloninger, Sigvardsson, & Bohman, 1996). For example, Depressive Alcoholism was long considered more common in women than in men and research efforts pertaining to “female alcoholism” have lagged behind those pertaining to “male alcoholism” (Wilsnack & Wilsnack, 1997). Recent studies show elevated rates of negative affect-related disorders (i.e., depression or anxiety) in men with versus men without alcohol use disorders, although comorbidity rates of negative affect and substance use disorders remain higher in women (Kessler, Crum, Warner, & Nelson, 1997). Moreover, Depressive Alcoholism was posited to be of late-onset (Cloninger