Alcohol use disorders and internalizing disorders are highly comorbid in adults, but how this comorbidity unfolds over development is not well understood. Previous retrospective studies in adults have shown that internalizing problems are associated with a rapid transition from first drink and first regular drinking to the onset of alcohol dependence. Some results also suggest that internalizing is a stronger predictor of rapid transitions through later stages of alcohol involvement, but these stage-specific effects have not been explicitly tested. The present study utilized a prospective dataset to investigate effects of adolescent internalizing symptoms on speed of transition through multiple stages of alcohol involvement. Specifically, it was hypothesized that greater early internalizing symptoms would predict a later age of first drink, a slower transition from first drink to first binge, and a faster transition from first binge to first dependence symptom. The moderating effects of gender were also examined. Data were from a longitudinal study of children of alcoholics and matched controls (n = 454) followed from late childhood to mid-life. Linear regression and Cox regression were the primary analytic strategies. Covariates were externalizing symptoms, family history of alcohol use disorders, and gender. Analyses also controlled for age at which the participant entered each interval. Generally, stage-specific hypotheses concerning the effects of internalizing were not supported. Internalizing symptoms marginally predicted an earlier age of first drink and a faster transition from first binge to first dependence symptom, and significantly predicted a faster transition through the overall interval from first drink to first dependence symptom. Internalizing was a stronger predictor of rapid transitions for women, and the effects of internalizing were not specific to early or later stages of alcohol involvement among women. These results suggest that early internalizing problems are a general risk factor for a rapid transition through all stages of alcohol involvement, and this risk may be stronger for women than for men. These results have important implications for our theoretical understanding of the relationship between internalizing problems and alcohol use disorders as well as prevention and intervention efforts targeting these problems.

Research has shown that a developmental process of maturing out of alcohol involvement occurs during young adulthood, and that this process is related to both young adult role transitions (e.g., marriage) and personality developmental (e.g., decreased disinhibition and neuroticism). The current study extended past research by testing whether protective marriage and personality effects on maturing out were stronger among more severe late adolescent drinkers, and whether protective marriage effects were stronger among those who experienced more personality development. Parental alcoholism and gender were tested as moderators of marriage, personality, and late adolescent drinking effects on maturing out; and as distal predictors mediated by these effects. Participants were a subsample (N = 844; 51% children of alcoholics; 53% male, 71% non-Hispanic Caucasian, 27% Hispanic; Chassin, Barrera, Bech, & Kossak-Fuller, 1992) from a larger longitudinal study of familial alcoholism. Hypotheses were tested with latent growth models characterizing alcohol consumption and drinking consequence trajectories from late adolescence to adulthood (age 17-40). Past findings were replicated by showing protective effects of becoming married, sensation-seeking reductions, and neuroticism reductions on the drinking trajectories. Moderation tests showed that protective marriage effects on the drinking trajectories were stronger among those with higher pre-marriage drinking in late adolescence (i.e., higher growth intercepts). This might reflect role socialization mechanisms such that more severe drinking produces more conflict with the demands of new roles (i.e., role incompatibility), thus requiring greater drinking reductions to resolve this conflict. In contrast, little evidence was found for moderation of personality effects by late adolescent drinking or for moderation of marriage effects by personality. Parental alcoholism findings suggested complex moderated mediation pathways. Parental alcoholism predicted less drinking reduction through decreasing the likelihood of marriage (mediation) and muting marriage's effect on the drinking trajectories (moderation), but parental alcoholism also predicted more drinking reduction through increasing initial drinking in late adolescence (mediation). The current study provides new insights into naturally occurring processes of recovery during young adulthood and suggests that developmentally-tailored interventions for young adults could harness these natural recovery processes (e.g., by integrating role incompatibility themes and addressing factors that block role effects among those with familial alcoholism).