We investigated the relative influence of genes and environment on the decision to seek treatment for alcoholism under three models of health care utilization. Lifetime alcohol dependence and two measures of treatment seeking for alcohol problems were determined from a 1992 telephone administration of the Diagnostic interview Schedule. Data were analyzed from 1,864 monozygotic and 1,492 dizygotic male twin respondents from the Vietnam Era Twin Registry. Genetic and environmental contributions to the decision to seek treatment for alcoholism were assessed under competing models for the relationship between genetic influences on alcoholism risk and genetic influences on treatment seeking among those who became alcoholics. Under the best-fitting model, genetic influence accounted for 41% of the variance in treatment seeking and 55% of the liability for alcoholism. Shared environment explained none of the variance in liability for alcoholism, but 40% of the variance in treatment seeking. The severity of alcoholism alone is an inadequate model of treatment seeking, because decisions to seek alcohol treatment are also influenced by substantial genetic and or shared environmental factors unrelated to the determinants of alcoholism.