This chapter discusses current conceptualizations of heterogeneity in alcohol use disorder (AUD), characterizes developmental pathways that lead to different subtypes of AUDs, and discusses how such pathways can inform preventive program design. Specifically, it reviews the “internalizing” and “externalizing” developmental pathways to AUDs. The externalizing pathway is characterized by a core deficit in behavioral control, whereas the internalizing pathway is characterized by a core deficit in emotion regulation. Both pathways predict drinking onset and escalation to AUD for some individuals. The chapter calls for the development of interventions to treat early childhood precursors to AUDs, innovative methods to identify individuals at risk for early emerging AUDs, additional investigation of how core pathway deficits operate across development, and greater consideration of how externalizing and internalizing pathways may interact within and across individuals.
