may abstain from drinking for religious, health, or other reasons. For complex disorders (i.e., disorders caused by many genes with small effects along with environmental factors) such as AUD, many patients are not expected to have a positive family history, consistent with the polygenic theory (Baselmans et al., 2021, Yang et al., 2010, Wray et al., 2020). For instance, assuming 10% disease prevalence and 50% heritability, up to 65% of patients will not have a positive family history depending on the family size (Yang et al., 2010). Based on a U.S. national survey, about 50% of male and 43% of female patients with AUD did not report a family history of alcohol use problems (Khan et al., 2013). Therefore, relying on family history as the primary predictor of risk to identify those who would benefit from early intervention would miss many high-risk individuals (Wray et al., 2020, Abul-Husn and Kenny, 2019).
