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are from 1463 twin individuals (60.5% female) in the population\u2010based\n FinnTwin12<\/jats:styled-content>\n cohort born 1983\u20131987.\n PAU<\/jats:styled-content>\n was assessed at ages 14, 22 and 37 using symptoms of alcohol use disorder (\n AUD<\/jats:styled-content>\n ) obtained from psychiatric interviews,\n mmMAST<\/jats:styled-content>\n scores, and the\n AUDIT<\/jats:styled-content>\n . Self\u2010reported health and well\u2010being were assessed at age 37. A behavioral and environmental risk index (\n BERI<\/jats:styled-content>\n ) was created by summing six risk factors: low socioeconomic status in childhood, family history of\n AUD<\/jats:styled-content>\n , childhood externalizing and internalizing behaviors, adolescent substance use, peer substance use, and stressful life events in adolescence. The twins' genetic predispositions were indexed using polygenic scores for externalizing behavior (\n \n PGS\n EXT<\/jats:sub>\n <\/jats:styled-content>\n ),\n PAU<\/jats:styled-content>\n (\n \n PGS\n PAU<\/jats:sub>\n <\/jats:styled-content>\n ), and depression (\n \n PGS\n MDD<\/jats:sub>\n <\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Twins were classified into four\n PAU<\/jats:styled-content>\n groups:\n Never<\/jats:italic>\n (\n n<\/jats:italic>\n \u2009=\u2009599, reference),\n Remitted<\/jats:italic>\n (\n n<\/jats:italic>\n \u2009=\u2009480),\n Persistent<\/jats:italic>\n (\n n<\/jats:italic>\n \u2009=\u2009271), and\n Late\u2010onset<\/jats:italic>\n (\n n<\/jats:italic>\n \u2009=\u2009113). When included in the same model, both\n BERI<\/jats:styled-content>\n and\n \n PGS\n EXT<\/jats:sub>\n <\/jats:styled-content>\n were significantly associated with\n Remitted<\/jats:italic>\n PAU<\/jats:styled-content>\n , while\n BERI<\/jats:styled-content>\n scores and\n \n PGS\n PAU<\/jats:sub>\n <\/jats:styled-content>\n were significantly associated with\n Persistent<\/jats:italic>\n PAU<\/jats:styled-content>\n . Compared to the\n Never<\/jats:italic>\n PAU<\/jats:styled-content>\n group, individuals in the\n Persistent<\/jats:italic>\n and\n Late\u2010onset<\/jats:italic>\n PAU<\/jats:styled-content>\n groups reported lower educational attainment, poorer physical health, lower relationship satisfaction, lower life satisfaction, a worse financial situation, more depressive symptoms, recurrent pain, and sleep problems, and were less likely to be partnered or have children.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Persistent<\/jats:italic>\n PAU<\/jats:styled-content>\n was associated with the most negative outcomes in early midlife, and childhood and adolescent risk factors and genetic risk as indexed by\n \n PGS\n PAU<\/jats:sub>\n <\/jats:styled-content>\n were strong predictors of group membership.\n Late\u2010onset<\/jats:italic>\n PAU<\/jats:styled-content>\n may be the result of novel stressors in adulthood, given the lack of association with childhood and adolescent environmental risk or genetic risk.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/acer.70365","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T08:14:30Z","timestamp":1782807270000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Patterns, Predictors, and Correlates of Problematic Alcohol Use and Remission From Adolescence to Early Midlife"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9405-367X","authenticated-orcid":false,"given":"Megan E.","family":"Cooke","sequence":"first","affiliation":[{"name":"Department of Psychiatry Robert Wood Johnson Medical School, Rutgers University Piscataway New Jersey USA"},{"name":"Rutgers Addiction Research Center Brain Health Institute, Rutgers Health Piscataway New Jersey 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