Significant increases in the prevalence of alcohol use and of binge drinking over the past 10 to 15 years were observed, but not for all demographic groups. However, the increase in binge drinking among middle-aged and older adults is substantial and may be driving increasing rates of alcohol-related morbidity and mortality.

Key to an understanding of alcohol use disorder (AUD) are the drinking-related reductions that begin in young adulthood and continue throughout the adult lifespan. Research is needed to precisely characterize the form of these reductions, including possible developmental differences across the lifespan. Using U.S.-representative data, we estimated multiple-group Markov models characterizing longitudinal transitions among five drinking statuses and differences in transition patterns across six adult age periods. While past research indicates relative developmental stability in AUD-desistance rates, we found far higher rates of-AUD desistance in young adulthood relative to later ages. Especially considering the dramatic change reflected by Severe-AUD desistance (from 6+ symptoms to 0-1 symptoms), this result indicates a substantial developmental shift, with Severe-AUD-desistance rates peaking at 43-50% across ages 25-34 and then dropping to 22-24% across ages 35-55. We discuss implications regarding practical significance of young-adult "maturing out" and predictions regarding lifespan variability in desistance .

Background Understanding the comorbidity of alcohol use disorder (AUD) and other psychiatric diagnoses has been a long‐standing interest of researchers and mental health professionals. Comorbidity is often examined via the diagnostic co‐occurrence of discrete, categorical diagnoses, which is incongruent with increasingly supported dimensional approaches of psychiatric classification and diagnosis, and for AUD more specifically. The present study examined associations between DSM‐5 AUD and psychiatric symptoms of other DSM‐IV and DSM‐5 disorders categorically, and dimensionally organized according to the Hierarchical Taxonomy of Psychopathology (HiTOP) spectra (e.g., Internalizing, Disinhibited Externalizing). Methods The comorbidity of AUD with other psychological disorders was examined in 2 independent nationally representative samples of past‐year drinkers via an initial examination in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) Wave 2 and replicated in NESARC‐III. Results Analyses focusing on psychopathology symptom counts organized by spectra demonstrated that greater AUD severity was associated with a higher number of symptoms across HiTOP spectra. Traditional categorical analyses also demonstrated increasing prevalence as a monotonic function of DSM‐5 AUD severity gradients. Conclusions This study indicates that AUD and other psychiatric disorder comorbidity implies increased presence of multiple forms of psychopathology with a corresponding increased number of symptoms across hierarchical spectra. Greater AUD severity increases the likelihood of other psychopathology and, when present, “more severe” presentations. That is, on average, a given disorder (e.g., depression) is more severe when copresenting with an AUD, and increases in severity along with the AUD.

Background: The externalizing spectrum contains a range of disinhibition-related conditions, such as conduct disorder, antisocial personality disorder, and substance use disorders. Comorbidity among externalizing disorders is commonly investigated at the syndromal and trait level precluding insight into the relationship of symptoms across externalizing disorders. It is unknown whether comorbidity across externalizing disorders holds constant across highly varied, individual alcohol use disorder (AUD) criteria. AUD criteria range from symptoms reflecting neuroadaptation (e.g., tolerance) to symptoms reflecting behavioral problems (e.g., social problems). The present study aimed to determine the degree to which individual AUD criteria are associated with symptomatology from other externalizing disorders. Characterization of the degree to which AUD criteria reflect neuroadaptation versus behavioral problems can be used to identify symptom profiles, which, in turn, can be used to inform diagnostic and treatment approaches.Methods: Data from 2 large nationally representative samples were used to examine associations between AUD criteria and externalizing behavior. Psychometric inquiries via multivariate and factor analytic approaches estimated relative associations of externalizing behavior and AUD criteria endorsement, as compared to alcohol consumption.Results: Our results indicate differential relations of externalizing behavior and AUD criteria endorsement. For example, social problems and role interference criteria were most strongly associated with externalizing behavior across analytic approaches, with general and unique associations with externalizing behavior. Additionally, tolerance was most weakly associated with externalizing behavior across approaches.Conclusions: Results highlight potential etiological heterogeneity among AUD criteria that could guide future diagnostic refinements and aid in the identification of treatment targets.

Addiction is a growing public health crisis, yet comparatively very few health services psychology programs include formal training in addiction science (Dimoff, Sayette, & Norcross, 2017). Health services psychologists (i.e., psychologists who integrate psychological science and practice to understand development and functioning; APA, 2015) are well suited to study and treat addiction, and doctoral-level training is an ideal time to prepare future health services psychologists to do so. One possible barrier to incorporating addiction science training is the necessity of a multidisciplinary approach to study and treat addiction and related health behaviors. We focus primarily on clinical science training and argue for a multifaceted approach to doctoral training in addiction science that would prepare trainees for research careers. The proposed training model emphasizes the importance of mentorship, coursework, grant preparation, responsible conduct of research, prevention, intervention, and treatment and invited speakers and conference attendance. Each of these components is discussed with an emphasis on addiction science. We offer suggestions for incorporating portions of this training model for programs with few addiction science-related resources. We also discuss the importance of enhancing diversity and inclusion in addiction training and offer brief recommendations on this topic. Public Significance StatementAddiction is a growing public health crisis. Health services psychologists are in a unique position to contribute to the understanding and treatment of this problem. This article describes important training considerations for health services psychology doctoral programs.