Etiopathogenesis of alcohol dependence syndrome is complex. Multiple interrelated and interacting factors are implicated in causation of alcohol dependence. Family history of alcoholism has been implicated as one of the key risk factors for developing alcohol dependence. Alcohol dependence syndrome is known to run in families, and this familial type of alcoholism has different clinical profile including earlier age of onset of drinking[1] and more severe pattern of drinking.[2] We present a case of alcohol dependence syndrome in family in which alcohol dependence is present in their four generations. A 43-year-old, Hindu, woman educated up to 10th standard, married for 26 years, working as a saloon owner for 10 years, was brought by husband and son-in-law to psychiatry outpatient department with chief complaints of excessive consumption of alcohol since last 2 years, irritable aggressive behavior toward family, decreased concentration at work, and generalized weakness. The patient was apparently alright 2 years ago when due to worries of downsizing of her work due to competition along with worries about her injured son in road traffic accident she started feeling increasingly overwhelmed and helpless about her situation. After the consumption of alcohol in one marriage ceremony, she felt better and relieved of her stressful emotions. After that she started consuming alcohol quite regularly to get relieved of her stress. She gradually increased her consumption of alcohol. She also had decreased concentration at her workplace and increasingly irritable behavior toward her family members. She was noticed and confronted by her husband about her alcohol consumption after which she stopped alcohol consumption for few months and restarted again after that due to irresistible craving. Due to lockdown, she faced unavailability of alcohol after which she involved her son into her alcohol drinking behavior where son used to procure alcohol and bring it to home for his mother and in return son would also get his share of alcohol. Gradually, son also became alcohol dependent. In the last 2 months, consumption of both patient and her son increased to 360 ml of vodka per day each and their drinking pattern also became eye opener type. Their increased consumption of alcohol and behavioral issues related to it was noticed by patient's husband. They were taken to some private psychiatrist but with no improvement. Finally, the patient and her son were brought to our OPD. On further enquiry, there was no significant medical or surgical history, but in family history, patient's mother had a history of chronic alcohol consumption and passed away due to liver failure complications. Furthermore, patient's maternal grandmother had a history suggestive of alcohol dependence. On mental status examination of both patient and her son, apart from mild-to-moderate withdrawal symptoms of alcohol and craving for alcohol other examination was normal. Diagnoses of alcohol use disorder were made in both patient and her son. Both were started on tablet clordiazepoxide 25 mg QID which was later down titrated and stopped. Furthermore, thiamine supplement along with other symptomatic management was given. Motivational enhancement therapy along with family therapy was given to both the patient and her son, currently both are maintaining well with regular follow-ups. The presence of family history of alcohol dependence is a key predictor of development of alcohol dependence in an index person. Researchers have noted that the odds of alcohol dependence increased by 167% when first, second or third degree relative was affected by alcohol dependence.[1] However, this familial effect encompasses both genetic effect and intrafamilial environmental effect. Genetic component plays a significant part in heritability of alcohol dependence syndrome. Twin studies and adoption studies showed this heritability to be 0.49.[3] Some studies have also found out specific genes related to alcohol dependence syndrome such as GABRA2[4] and ADH1B.[5] Other theories supporting inheritability of alcoholism implies that alcoholic behavior is inherited primarily by inheritance of predisposing personality type or inheritance of the metabolism pathways of alcohol which is also under genetic control.[6] However, familial and cultural factors also have been shown to be equally important in causation of alcohol dependence syndrome[7] as these are the factors which actually determine whether person actually consumes alcohol or not. These factors may include decreased intrafamilial communication, decreased parental monitoring, intrafamilial conflicts, and harsh parenting practices.[89] Clinically, familial alcohol dependence also differs from nonfamilial alcohol dependence patients in that they have young age of onset, more sever dependence, childhood history of hyperactivity and conduct disorder, and adulthood antisocial behavior.[10] Thus, from the current evidence, it can be definitely suggested that those who have family history of alcohol dependence are vulnerable for developing alcohol dependence themselves and should approach drinking alcohol more cautiously. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.