Alcohol milestones and internalizing, externalizing, and executive function: longitudinal and polygenic score associations

Sarah E. Paul, David A.A. Baranger, Emma Johnson, Joshua J. Jackson, Aaron J. Gorelik, Alex P. Miller, Alexander S. Hatoum, Wesley K. Thompson, Michael Strube, Danielle M. Dick, Chella Kamarajan, John R. Kramer, Martin H. Plawecki, Grace Chan, Andrey P. Anokhin, David B. Chorlian, Sivan Kinreich, Jacquelyn L. Meyers, Bernice Porjesz, Howard J. EdenbergArpana Agrawal, Kathleen K. Bucholz, Ryan Bogdan

Research output: Contribution to journalArticlepeer-review


Background. Although the link between alcohol involvement and behavioral phenotypes (e.g. impulsivity, negative affect, executive function [EF]) is well-established, the directionality of these associations, specificity to stages of alcohol involvement, and extent of shared genetic liability remain unclear. We estimate longitudinal associations between transitions among alcohol milestones, behavioral phenotypes, and indices of genetic risk. Methods. Data came from the Collaborative Study on the Genetics of Alcoholism (n = 3681; ages 11-36). Alcohol transitions (first: drink, intoxication, alcohol use disorder [AUD] symptom, AUD diagnosis), internalizing, and externalizing phenotypes came from the Semi-Structured Assessment for the Genetics of Alcoholism. EF was measured with the Tower of London and Visual Span Tasks. Polygenic scores (PGS) were computed for alcohol-related and behavioral phenotypes. Cox models estimated associations among PGS, behavior, and alcohol milestones. Results. Externalizing phenotypes (e.g. conduct disorder symptoms) were associated with future initiation and drinking problems (hazard ratio (HR)≥1.16). Internalizing (e.g. social anxiety) was associated with hazards for progression from first drink to severe AUD (HR≥1.55). Initiation and AUD were associated with increased hazards for later depressive symptoms and suicidal ideation (HR≥1.38), and initiation was associated with increased hazards for future conduct symptoms (HR = 1.60). EF was not associated with alcohol transitions. Drinks per week PGS was linked with increased hazards for alcohol transitions (HR≥1.06). Problematic alcohol use PGS increased hazards for suicidal ideation (HR = 1.20). Conclusions. Behavioral markers of addiction vulnerability precede and follow alcohol transitions, highlighting dynamic, bidirectional relationships between behavior and emerging addiction.

Original languageEnglish
JournalPsychological medicine
StateAccepted/In press - 2024


  • ADHD
  • Alcohol initiation
  • alcohol intoxication
  • alcohol use disorder
  • conduct disorder
  • executive function
  • externalizing
  • internalizing
  • longitudinal
  • polygenic scores
  • social anxiety
  • suicidal ideation


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