title: The clinical and cost-effectiveness of brief advice for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial.
abstract: OBJECTIVE
  To examine the clinical and cost-effectiveness of brief advice for excessive alcohol consumption among people who attend sexual health clinics.
  
  
  METHODS
  Two-arm, parallel group, assessor blind, pragmatic, randomised controlled trial. 802 people aged 19 years or over who attended one of three sexual health clinics and were drinking excessively were randomised to either brief advice or control treatment. Brief advice consisted of feedback on alcohol and health, written information and an offer of an appointment with an Alcohol Health Worker. Control participants received a leaflet on health and lifestyle. The primary outcome was mean weekly alcohol consumption during the previous 90 days measured 6 months after randomisation. The main secondary outcome was unprotected sex during this period.
  
  
  RESULTS
  Among the 402 randomised to brief advice, 397 (99%) received it. The adjusted mean difference in alcohol consumption at 6 months was -2.33 units per week (95% CI -4.69 to 0.03, p=0.053) among those in the active compared to the control arm of the trial. Unprotected sex was reported by 154 (53%) of those who received brief advice, and 178 (59%) controls (adjusted OR=0.89, 95% CI 0.63 to 1.25, p=0.496). There were no significant differences in costs between study groups at 6 months.
  
  
  CONCLUSIONS
  Introduction of universal screening and brief advice for excessive alcohol use among people attending sexual health clinics does not result in clinically important reductions in alcohol consumption or provide a cost-effective use of resources.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN 99963322.
authors.affiliation: Centre for Mental Health, Imperial College, London, UK.
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Crawford
authors.affiliation: Centre for Mental Health, Imperial College, London, UK.
authors.forename: Rahil
authors.initials: R
authors.lastname: Sanatinia
authors.affiliation: Centre for the Economics of Mental and Physical Health, King's College London, London, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Barrett
authors.affiliation: Centre for the Economics of Mental and Physical Health, King's College London, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Byford
authors.affiliation: Centre for Mental Health, Imperial College, London, UK.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Dean
authors.affiliation: Central and North West London NHS Foundation Trust, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Green
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Jones
authors.affiliation: PRIMENT Clinical Trials Unit, University College, London, UK.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Leurent
authors.affiliation: MRC Biostatistics Unit, Cambridge, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sweeting
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Touquet
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Greene
authors.affiliation: Centre for Mental Health, Imperial College, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Tyrer
authors.affiliation: School of Public Health, Imperial College, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Ward
authors.affiliation: Centre for Neuropsychopharamacology, Imperial College, London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Lingford-Hughes
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000523:psychology*; D003362:Cost-Benefit Analysis; D005260:Female; D006266:Health Education / Q000191:economics / Q000379:methods*; D006801:Humans; D008297:Male; D012725:Sexual Behavior / Q000187:drug effects*; D012749:Sexually Transmitted Diseases / Q000191:economics / Q000517:prevention & control* / Q000635:transmission*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Clinical Trials; Sexual Behaviour; Substance Misuse