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Alcohol response phenotype may be an important factor underlying vulnerability to and progression of AUD. This study examined the prospective association between acute alcohol responses and continued or remitted AUD over time in young adults with AUD. This sample was\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009101 AUD participants (M\n                      <jats:sub>age<\/jats:sub>\n                      =27.1\u2009\u00b1\u20094.0\u2009SD\u2009yrs) comprising the third cohort of the Chicago Social Drinking Project. They completed two beverage challenge\u00a0 laboratory sessions (0.8\u2009g\/kg fixed-dose alcohol\n                      <jats:italic>vs<\/jats:italic>\n                      . placebo) and four years of follow-up to ascertain future AUD symptoms, drinking behaviors, and consequences. Retention was high with an overall 99.2% follow-up rate. Analyses identified three AUD trajectory subgroups over follow-up including a high AUD trajectory subgroup (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200937), a medium AUD trajectory subgroup (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200948), and a low AUD trajectory subgroup (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916). Generalized estimating equations showed that greater sensitivity to alcohol\u2019s pleasurable effects, including stimulation\u00a0and hedonic and motivational reward\u00a0(liking and wanting, respectively)\u00a0predicted more AUD symptoms over follow-up (\n                      <jats:italic>p<\/jats:italic>\n                      s&lt;0.001)\u00a0and were positively associated with AUD trajectory subgroups. However,\u00a0 sedation, heart rate, and cortisol\u00a0response to alcohol\u00a0were not\u00a0 significantly associated with AUD trajectory subgroups. In sum, greater alcohol stimulation, liking, and\u00a0wanting prospectively predicted the continuation and increasing\u00a0severity of AUD over a four-year period. The findings challenge theoretical models emphasizing reward deficit and global tolerance in addiction and support the role of positive reinforcement, indexed by sensitivity to alcohol\u2019s pleasurable effects, as an important factor in AUD\u00a0 persistence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial<\/jats:title>\n                    <jats:p>\n                      Name: Chicago Social Drinking Project\n                      <jats:bold>Registration #:<\/jats:bold>\n                      NCT00961792\n                      <jats:bold>URL:<\/jats:bold>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\/ct2\/show\/NCT00961792\" ext-link-type=\"uri\">http:\/\/clinicaltrials.gov\/ct2\/show\/NCT00961792<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41386-026-02572-2","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:27:36Z","timestamp":1791829656000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Testing neurobiological models of reward\/incentive sensitization in the continuation of alcohol use disorder (AUD) symptoms in young adults with AUD: A four-year longitudinal study"],"prefix":"10.1038","author":[{"given":"Andrea C.","family":"King","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel K.","family":"Nordgren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dingcai","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire E.","family":"Wellendorf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Fridberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"2572_CR1","unstructured":"Center for Disease Control and Prevention. 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