There are several potential implications of these data. First, they indicate that BOLD response contrast results related to the low LR to alcohol can predict drinking behaviors over extended periods of time. The modest proportion of the variance in predicting outcomes reported here is consistent with prior studies of heavy drinking and AUDs that underscore the importance of many genetic and environmental factors in the genesis of adverse drinking outcomes, with no one element both necessary and sufficient (Schuckit, 2014). Regarding LR, the finding that perturbations in the prefrontal and insular regions appear to be associated with both a low LR and future heavy drinking may improve our ability to more accurately identify the LR-related phenotype compared to results from alcohol challenge-related changes in subjective feelings of intoxication and related characteristics (see Paulus et al., 2012). This, in turn, may open the door to a more optimal multi-level process model that helps explain at least one aspect of the vulnerability toward problem drinking associated with LR itself.
