It looks like Visual studio has changed it's implementation of selecting text with Alt+LButtonDown. In Visual Studio 2019, any cursor movement would cancel the selection. In Visual Studio 2022, only the Esc key will cancel the column selection. Visual Studio 2022 is creating multiple cursors and not creating a single column selection with one cursor (not sure what 2019 was doing).
To create a Visual Studio 2022 style of column selection, hold down Shift and use the Right mouse button. Shift+RButtonDn and drag.
The binding for Shift+RButtonDn is mou-click-block-add-cursors. This is like Visual Studio 2022 Alt+LButtonDn which adds a cursor/selection per line.
The binding for Alt+LButtonDn is mou-click-copy-block. This creates a single cursor column selection. The one you seem not to like. More similar to Visual Studio 2019 and before.
One clear downside to multiple cursors is that it can't handle many thousands of lines/cursors. Not sure what the limit is. A single column selection can contain any number of lines (millions and more). Other than that limit, this is totally a user preference thing for sure. I mostly avoid multiple cursors because they trip me up. I'm way too used to a single selection and cursor being created and for any cursor movement to cancel the selection like all other selections.