Our results provide important evidence for the role of alcohol stimulation and reward sensitivity, in addition to lower sedation, in the development of future AUD symptoms and persistence and exacerbation of bingeing and other drinking behaviors. The study extends our previous findings (16) to a critical longer 6-year follow-up interval when most participants were entering their third decade of life and provides crucial and broader longitudinal evidence to reconcile theoretical debate about models of alcohol response and risk for future drinking problems. Young adult heavy drinkers who exhibited an alcohol response phenotype characterized by greater sensitivity to stimulant and rewarding effects progressed in their drinking and reported more AUD symptoms over a 6-year interval approaching their early 30s compared with those without this response profile. The high and intermediate AUD trajectory groups showed clinically relevant signs of departure from drinking norms over follow-up: average binge-drinking frequency throughout follow-up was 62% and 40% of days, respectively, compared with 28% of days in the low AUD group. Furthermore, these groups averaged 6.6 and 3.2 AUD symptoms, respectively, during their heaviest follow-up. Extrapolating
