Background: The central issue of this paper is whether the intuitive relation between problematic drinking and seeking professional help holds. To shed light on this issue an ecological study is done in which the relation between different drinking patterns, alcohol-related harm, and help-seeking behaviour at the neighbourhood level of Rotterdam, The Netherlands is examined. Two questions are posed:1. Are there geographical differences in drinking patterns, alcohol problems, problem drinking, and number of alcohol clients within the city of Rotterdam?2. Is there a relation between drinking patterns, alcohol-related harm, and help-seeking behaviour at the neighbourhood level? Methods: Ecological analyses are conducted based on individual data originating from a survey and person-based registers. Respondents to the survey were classified as abstainers, light, moderate or excessive drinkers, and were classified as having alcohol-related problems and/or being a problem drinker. Person-based registers were used to obtain data on the number of ambulatory and clinical alcohol clients in Rotterdam. The number of ambulatory and clinical clients measured help-seeking behaviour. Results: The intuitive reasoning that the more problematic drinkers, the more professional help is sought does not stand. No association was found between the number of alcohol clients and the percentage of excessive drinkers and problem drinkers at the neighbourhood level. Large differences between neighbourhoods in prevalence of excessive drinking, alcohol-related problems and problem drinking were found. The number of alcohol clients, however, varied much less between neighbourhoods. A notable result is that the higher the percentage of abstainers, the lower the number of alcohol clients in a neighbourhood. Discussion: It was concluded that in all neighbourhoods the number of problem drinkers outnumbers those seeking professional help, indicating a friction between need and supply of help with respect to problematic drinking. It is hypothesised that besides drinking behaviour and drinking-related problems individual, as well as social and cultural factors, play a role in the process of help-seeking behaviour.