An internalizing pathway to alcohol and substance use disorders

Research emanating from the field of developmental science indicates that initial risk factors for substance use disorder can be evident in early childhood. One dominant developmental pathway connecting these initial risk factors with subsequent substance use disorders focuses on the central role of disinhibited or externalizing behaviors. In the current paper, we delineate a second pathway that focuses on problems with emotion regulation associated with internalizing symptomatology. Several studies indicate that internalizing symptoms in early and middle childhood predict substance involvement in adolescents and young adulthood. We describe a risk model that traces the potential developmental markers of this internalizing pathway to substance use disorders and that identifies a population potentially vulnerable to this risk process, namely children of alcoholic parents. We consider the relation between the internalizing pathway and the more widely researched externalizing pathway. We then conclude with a discussion of the implications of this model for prevention efforts. In this manner, we strive for a translational goal, linking our existing understanding of internalizing processes and substance use disorders with our efforts to develop effective prevention programs