However, by itself, a low LR cannot fully explain how heavy drinking and associated problems develop. Therefore, efforts have been made to understand more about the pathways through which a low LR contributes to such an enhanced risk [10, 12–14]. Tests of the overall hypothesized LR-based model have shown that a low LR relates to what a person expects to occur during drinking periods, with these expectations contributing to heavier drinking, perhaps through the belief that heavier drinking and alcohol problems are acceptable behaviors [12, 13, 15–17]. In these models the impact of LR on alcohol-related outcomes was also mediated through sub-optimal coping approaches, especially the use of alcohol to alleviate stress, with problematic coping practices contributing to the risk for higher levels of alcohol intake and related problems [10, 13, 18–20]. The models also supported a relationship between alcohol expectancies and the use of alcohol to cope with stress [12, 21].
