Background In observational studies, moderate drinking is associated with a reduced risk of more than twenty different diseases and health problems. However, it would be premature to conclude that there is a causal relationship. Method This paper critically reviews the evidence for such associations. Findings It was found that reasons for questioning the causal association of moderate drinking and a reduced health risk are: the lack of dose-response relationships; the characteristics and lifestyles of today's abstainers and moderate drinkers; the lack of plausible biological mechanisms; the problems in the classification of drinking groups, and; the general limitations of observational studies. Conclusions The evidence for the harmful effects of alcohol is undoubtedly stronger than the evidence for beneficial effects.

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<strong><span style="font-family: TimesNewRomanPS-BoldMT;"><span style="font-family: TimesNewRomanPS-BoldMT;"><p align="left"> </p></span></span><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">SAMMENDRAG</span></span></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">I de siste tiårene har bekymringen for alkoholproblemer vært knyttet til begreper som "alkoholiker" eller "de som</p><p align="left">har alkoholproblemer". Begrepene impliserer at de fleste problemene er langvarige tilstander hos en avgrenset,</p><p align="left">behandlingstrengende gruppe. Den foreliggende undersøkelsen var lagt opp som en post-enquete. Skjemaene ble</p><p align="left">sendt til et representativt utvalg Oslo-borgere i alderen 18-59 år. En mottok 2051 skjemaer og oppnådde en svarprosent</p><p align="left">på 77. Respondentene ble spurt om de hadde opplevet 8 typer skadevirkninger knyttet til sin alkoholbruk.</p><p align="left">Avhengig av antall skadevirkninger ble personens alkoholproblemer definert som moderate, betydelige eller store.</p><p align="left">Hvis "alkoholisme" defineres som å ha opplevet et visst antall av de 8 problemene, varierer antall "alkoholikere"</p><p align="left">dramatisk avhengig av antall skadevirkninger som kreves: Hvis det kreves 7 problemer, er færre enn 1% av denne</p><p align="left">befolkningen alkoholikere. Hvis det kreves 3 problemer er 21% alkoholikere. Hyppigheten av alkoholproblemer</p><p align="left">reduseres gradvis med økende alder, fra 29% mellom 18 og 25 års alder til 8% mellom 45 og 60 år. De aller fleste</p><p align="left">alkoholproblemer er ikke knyttet til daglig drikking eller til et svært høyt forbruk pr. år. De fleste som noen gang</p><p align="left">har opplevet betydelige eller store problemer synes å "modne ut" av problemdrikking uten å stoppe å drikke og</p><p align="left">uten noen form for behandling. De fleste som har betydelige eller store problemer har ikke ønsket å kutte sin</p><p align="left">alkoholbruk ut eller sterkt ned. Blant dem som har ønsket det, har over 90% klart det helt eller delvis. Undersøkelsen</p><p align="left">bekrefter tidligere befolkningsstudier som indikerer at de fleste alkoholproblemer er spredt blant en stor</p><p align="left">andel av den yngre mannlige befolkningen som stort sett synes å ha kontroll over sin alkoholbruk, ikke kan kalles</p><p align="left">avhengige og ikke kommer til alkoholistbehandling. Artikkelen drøfter hvilke konsekvenser dette har for</p><p align="left">samfunnets strev for å redusere problemene.</p><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">Fekjær HO.</p></span></span></span><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left"> </p></span></span><p align="left"><strong><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">How many alcoholics do we have? Alcohol problems in the population of Oslo.</span></span></strong><em><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><em><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><p align="left">Nor J Epidemiol</p></span></span></em></span><em><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><p align="left"> </p></span></em></span><strong><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">ENGLISH SUMMARY</span></span></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">For the last decades, the concern for alcohol problems has been associated with the words "alcoholism" or</p><p align="left">"alcohol dependence", implying that most problems are long-lasting conditions within a delimited group in need</p><p align="left">of treatment. The present study used a mail questionnaire sent to a representative sample of Oslo's population in</p><p align="left">the age group 18-59 years. With a respondent rate of 77 percent, 2051 questionnaires were returned. The respondents</p><p align="left">were asked whether they had experienced 8 types of problems related to their alcohol use. Depending on the</p><p align="left">number of problems, the individual's alcohol problems were defined as moderate, substantial or major. If</p><p align="left">"alcoholism" is defined as having experienced a certain number of the 8 problems, the number of "alcoholics"</p><p align="left">varies dramatically with the number of problems required: If 7 problems are required, less than 1% of this population</p><p align="left">are alcoholics. If 3 problems are needed, 21% are alcoholics. The frequency of alcohol problems gradually</p><p align="left">decreases with increasing age, ranging from 29% between 18 and 25 years of age to 8% between 45 and 60 years.</p><p align="left">The vast majority of alcohol problems are not related to daily drinking or to a very high level of consumption per</p><p align="left">year. Most people who have experienced substantial or major problems during their lifetime seem to "mature out"</p><p align="left">of problem drinking without ceasing drinking and without any kind of treatment. The majority with substantial or</p><p align="left">major problems have not wanted to drastically reduce their consumption. Among those having wanted to do so,</p><p align="left">more than 90% have succeeded completely or partially. This study confirms earlier population studies which</p><p align="left">indicate that most alcohol problems are scattered within a large proportion of the younger male population, most</p><p align="left">of whom seem to be in control of their drinking habits, cannot be labelled dependent and do not seek alcoholism</p><p>treatment. The implications for society's struggle to reduce alcohol problems are discussed.</p></span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">1996; </span></span><strong><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">6 </span></span></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">(1): 23-28.</span></span></p>

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