There are several limitations in the study. First, information on parental AUD was obtained from the offspring rather than from the parents. Although family history data on AUD is highly specific, it tends to be less sensitive.47 Given the reduced sensitivity, some individuals classified with non-AUD parents may have had AUD parents. Also, the term parental AUD was used in this article to save space although the term parental AUD reported by offspring would have been correct. Second, cross-sectional data limit the ability to distinguish between genetic, conception, intrauterine, and environmental factors. Third, the NESARC sample excluded individuals in hospitals and correctional settings. If these individuals were assessed, our data could have encompassed more severe cases of AUD.
In conclusion, our study showed that offspring with 1 AUD parent are at 2.51-fold higher odds and offspring with 2 AUD parents are at 4.44-fold higher odds for lifetime AUD. Offspring of AUD parents, however, can be resilient.48 By utilizing these findings, clinicians may provide relevant education and administer screenings for AUD, which has been found to be a prevalent disorder affecting approximately 18%49 to 30%50 of the population. Asking patients about parental AUD is a highly efficient way of screening for AUD. Also, most parents prefer physicians to initiate discussion on parental alcohol use.51 Clinicians can play an active role in educating individuals with parental AUD and their families, providing resources, and discussing prevention52 and intervention53 to mitigate other risk factors of AUD.