First, COGA is a sample of individuals at high risk for AUD based on family history. Generalizability beyond high-risk samples is not recommended. Second, the current study separated “help-seeking” and “treatment utilization” which are both aspects of service use. Past studies use all three terms somewhat interchangeably and caution needs to be taken when comparing across studies. Third, COGA only ascertains sex, not gender, which limits the interpretability of some findings. Future studies need to thoroughly assess gender to see the extent of service use among all genders, including trans, gender non-binary, non-conforming, and gender fluid individuals. Fourth, there is limited representation in the COGA sample of Asian, Native American / Alaska Native, Pacific Islander, and those who identify by another race(s). Multiple studies have found racial / ethnic differences in service use (e.g., Chartier et al., 2011) as well as gender and race / ethnicity integrations (e.g., Pinedo et al., 2019; Zemore et al., 2014) that we were not powered to examine in the current study. Fifth and relatedly, Hispanic ethnicity was not asked separately in SSAGA-I and SSAGA-II,
