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The literature suggests that excessive alcohol use aimed at coping with INTD symptoms is, at best, a partial explanation for the high comorbidity rates observed. We hypothesized that individuals with INTD experience greater susceptibility to developing AUD symptoms due to the partially shared neurobiological dysfunctions underlying both conditions. We probe this hypothesis by testing the prediction that, after accounting for the volume of alcohol intake, individuals with INTD experience higher levels of alcohol\u2010related symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from the National Epidemiological Survey on Alcohol\u2010Related Conditions (NESARC) Wave 3 were used for the primary analyses, and NESARC Wave 1 data were used for independent replication analyses. Individuals who reported any alcohol use in the prior year were categorized as: (1) never having had an INTD diagnosis (\u201cINTD\u2010Never\u201d); (2) having a remitted INTD diagnosis only (\u201cINTD\u2010Remitted\u201d); or (3) having current INTD diagnosis (\u201cINTD\u2010Current\u201d). Between\u2010group contrasts of alcohol\u2010related symptoms controlled for total alcohol intake (past year), drinking pattern (e.g., binging) and variables previously shown to mark exaggerated AUD symptoms relative to drinking amount (e.g., SES, gender, and family history).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>With all covariates in the model, individuals in the INTD\u2010Current group and the INTD\u2010Remitted group reported significantly greater alcohol\u2010related symptoms than those in the INTD\u2010Never group but did not themselves differ in level of alcohol\u2010related symptoms. These results were replicated in the NESARC 1 dataset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Individuals with INTD experience more alcohol\u2010related symptoms than those who drink at the same level. While considering other explanations, we argue that this \u201charm paradox\u201d is best explained by the view that INTD confers a neurobiologically mediated susceptibility to the development of AUD symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.15036","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T15:02:50Z","timestamp":1682694170000},"page":"713-723","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Evidence for an alcohol\u2010related \u201charm paradox\u201d in individuals with internalizing disorders: Test and replication in two independent community samples"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2115-5170","authenticated-orcid":false,"given":"Justin J.","family":"Anker","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of Minnesota \u2013 Minneapolis  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Thuras","sequence":"additional","affiliation":[{"name":"Minneapolis VA Medical Center, Minneapolis  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7178-3423","authenticated-orcid":false,"given":"Ruichong","family":"Shuai","sequence":"additional","affiliation":[{"name":"School of Psychology University of Exeter  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee","family":"Hogarth","sequence":"additional","affiliation":[{"name":"School of Psychology University of Exeter  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8506-2053","authenticated-orcid":false,"given":"Matt G.","family":"Kushner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of Minnesota \u2013 Minneapolis  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.1375"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.alcohol.2018.03.009"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.35946\/arcr.v40.1.03"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2015.11.031"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.14963"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2010.12.014"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.12m08159"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.15567"},{"key":"e_1_2_8_10_1","first-page":"408","article-title":"Childhood trauma, posttraumatic stress disorder, and alcohol dependence","volume":"34","author":"Brady K.T.","year":"2012","journal-title":"Alcohol Research: Current Reviews"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2010.09.007"},{"key":"e_1_2_8_12_1","first-page":"484","article-title":"Genetic and environmental determinants of stress responding","volume":"34","author":"Clarke T.K.","year":"2012","journal-title":"Alcohol Health and Research World"},{"key":"e_1_2_8_13_1","unstructured":"Core Team. 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