{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T16:59:21Z","timestamp":1754153961646,"version":"3.41.2"},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["UG3DA059414"],"award-info":[{"award-number":["UG3DA059414"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["R01AA029077"],"award-info":[{"award-number":["R01AA029077"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alcohol, Clinical and Experimental Research"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Individuals with internalizing (anxiety and depressive) disorder (INTD) suffer from an alcohol\u2010related \u201charm paradox\u201d; that is, they experience more alcohol\u2010related symptoms in aggregate than do others who drink at the same level. Here, we extend this earlier finding by examining the association of INTD with a wide range of individual alcohol\u2010related symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study sample included respondents in the NESARC Wave 3 who reported having consumed alcohol in the past year (<jats:italic>N<\/jats:italic>\u2009=\u200924,485). We used logistic regression analysis to identify the association between INTD and risk for 37 individual alcohol symptoms. We used the BOSS causal discovery algorithm to identify the best\u2010fitting causal model for the full dataset and for 100 resampled datasets, each composed of a randomly selected 50% of the full dataset. Causal edges that appeared in at least 80% of the resampled datasets were deemed \u201chighly stable.\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After controlling for the level of daily alcohol volume and demographic variables, INTD significantly increased the relative odds of having all 37 alcohol\u2010related symptoms measured (ORs ranged from 1.5 to 4.6). Interactions between INTD and the level of alcohol use were largely nonsignificant. Highly stable direct (unmediated) causal edges emanated primarily from INTD to the symptoms of alcohol withdrawal and dependence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Those with INTD are at greater risk for a wide range of alcohol symptoms than others who drink at the same level, even at relatively low levels of alcohol use. We consider that INTD could exert a direct causal influence specifically on withdrawal and dependence symptoms due to overlapping experiential and\/or neurobiological aspects of these alcohol use symptoms and INTD. We conclude that the harm paradox likely contributes to the elevated risk of developing alcohol use disorder comorbidity among those with INTD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.70075","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T23:50:22Z","timestamp":1747957822000},"page":"1489-1503","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Correlational and causal modeling of alcohol\u2010related symptoms and internalizing disorder status: Further elucidation of a harm paradox"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2115-5170","authenticated-orcid":false,"given":"Justin","family":"Anker","sequence":"first","affiliation":[{"name":"University of Minnesota  Twin Cities Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Andrews","sequence":"additional","affiliation":[{"name":"University of Minnesota  Twin Cities Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erich","family":"Kummerfeld","sequence":"additional","affiliation":[{"name":"University of Minnesota  Twin Cities Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Thuras","sequence":"additional","affiliation":[{"name":"University of Minnesota  Twin Cities Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8506-2053","authenticated-orcid":false,"given":"Matt G.","family":"Kushner","sequence":"additional","affiliation":[{"name":"University of Minnesota  Twin Cities Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.alcohol.2018.03.009"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41060-017-0085-7"},{"key":"e_1_2_8_4_1","first-page":"63945","article-title":"Fast scalable and accurate discovery of DAGs using the best order score search and grow\u2010shrink trees","volume":"36","author":"Andrews B.","year":"2023","journal-title":"Advances in Neural Information Processing Systems"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.35946\/arcr.v40.1.03"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.15036"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2517-6161.1995.tb02031.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/scan\/nsu061"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/36.3.249"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2014.09.008"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2015.0584"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.61.8.807"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40473-018-0166-5"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-32-9705-0_9"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1997.01830160031005"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.psych.59.103006.093548"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.56.10.921"},{"key":"e_1_2_8_18_1","doi-asserted-by":"crossref","unstructured":"Kummerfeld E.&Rix A.(2019)Simulations evaluating resampling methods for causal discovery: ensemble performance and calibration. In:2019 IEEE international conference on bioinformatics and biomedicine (BIBM) pp. 2586\u20132593. IEEE.","DOI":"10.1109\/BIBM47256.2019.8983327"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-7358(99)00027-6"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.alc.0000175072.17623.f8"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-74290-8_1"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.15288\/jsad.2011.72.1019"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.15288\/jsad.2012.73.920"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.147.6.685"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.2011.01604.x"},{"key":"e_1_2_8_26_1","unstructured":"Lam W.\u2010Y. Andrews B.&Ramsey J.(2022)Greedy relaxations of the sparsest permutation algorithm.arXiv[csAI]. Available from:https:\/\/doi.org\/10.48550\/arXiv.2206.05421"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9868.2010.00740.x"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2010.10.006"},{"key":"e_1_2_8_29_1","unstructured":"R Core Team. (2021)R: a language and environment for statistical computing.Vienna Austria:R Foundation for Statistical Computing. Available from:https:\/\/www.r\u2010project.org\/[Accessed 28th August 2024]."},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnbeh.2022.821693"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4612-2748-9"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2021.01.051"},{"key":"e_1_2_8_33_1","unstructured":"Wickham H.&Miller E.(2019)haven: import and export \u201cSPSS\u201d \u201cStata\u201d and \u201cSAS\u201d files. R package version 2.1.1. Available from:https:\/\/CRAN.R\u2010project\/package=haven[Accessed 28th August 2024]."},{"key":"e_1_2_8_34_1","unstructured":"Wickham H. Fran\u00e7ois R. Henry L.&M\u00fcller K.(2021)dplyr: a grammar of data manipulation. Version 1.12. Available from:https:\/\/dplyr.tidyverse.org[Accessed 28th August 2024]."},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.15407"}],"container-title":["Alcohol, Clinical and Experimental Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acer.70075","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T16:25:44Z","timestamp":1753287944000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acer.70075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":34,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1111\/acer.70075"],"URL":"https:\/\/doi.org\/10.1111\/acer.70075","archive":["Portico"],"relation":{},"ISSN":["2993-7175","2993-7175"],"issn-type":[{"type":"print","value":"2993-7175"},{"type":"electronic","value":"2993-7175"}],"subject":[],"published":{"date-parts":[[2025,5,22]]},"assertion":[{"value":"2024-10-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}