Background Physical activity (PA) is increasingly recognised as a potential adjunct to psychosocial and pharmacological treatments for alcohol dependence (AD), with potential benefits for alcohol recovery, psychological wellbeing, and physical health. However, existing evidence of its effectiveness remains inconsistent. This systematic review and meta-analysis evaluated the effects of PA on alcohol-related, psychological, and physiological outcomes among adults with AD, and examined barriers and facilitators influencing engagement in PA during recovery. Methods A systematic search of MEDLINE, CINAHL, PsycINFO, and SPORTDiscus was conducted to April 2026 in accordance with PRISMA guidelines. Eligible studies included adults (≥ 18 years) with clinically diagnosed AD participating in PA or exercise interventions. Random-effects meta-analyses were conducted using Hedges’ g. Narrative and thematic synthesis integrated qualitative and non-meta-analysed findings. Risk of bias and certainty of evidence were assessed using validated appraisal tools and the GRADE framework. Results Twenty-one studies involving 1,460 participants were included, with nine contributing to meta-analysis. Studies were conducted primarily in the United States, Denmark, and India, with additional studies from Canada, Italy, Sweden, Germany, and Thailand. PA interventions significantly reduced alcohol craving (SMD = − 1.05, 95% CI − 1.92 to − 0.17), depression (SMD = − 1.06, 95% CI − 1.84 to − 0.29), anxiety (SMD = − 0.71, 95% CI − 1.26 to − 0.17), and stress (SMD = − 1.34, 95% CI − 2.38 to − 0.30), and improved aerobic capacity (VO₂max SMD = 0.57, 95% CI 0.25 to 0.89). No significant effect was observed for alcohol consumption. Evidence certainty ranged from very low to moderate. Narrative findings indicated that participants viewed PA positively, particularly structured and accessible activities such as walking. Common barriers included low motivation, fatigue, and limited facility access, while stress reduction, improved wellbeing, and social support facilitated participation. Conclusions PA may support psychological wellbeing and aerobic fitness in individuals recovering from AD. However, evidence for alcohol-related outcomes remains limited because of methodological heterogeneity, small sample sizes, and low-certainty evidence. Findings relating to craving, anxiety, and stress were based on few studies and should be interpreted cautiously. Further high-quality RCTs are needed to clarify effectiveness and implementation within treatment services. PROSPERO registration: CRD42021232904

BACKGROUND:Early detection of alcohol use disorder (AUD) amongst people admitted to general hospitals offers an opportunity for early intervention and accesses to evidence-based care. However, current operational models for the management of AUD in these settings are poorly defined, limiting the ability to assess their impact on individual patient outcomes, treatment effectiveness, or healthcare system efficiency. This scoping review aims to identify and characterize existing models of AUD management within general hospitals. METHODS:A scoping review approach was adopted, including relevant peer-reviewed publications between 1990 and 2025. Studies needed to report on ≥2 care components (systematic screening, brief interventions, medically assisted alcohol withdrawal, relapse prevention initiation, psychosocial interventions, transition to community, provision of training) to be included. Screening and data extraction were performed independently by at least reviewers. RESULTS:Fifty-one (n = 51) records were included, and four distinct models of care were identified (consultation liaison; screening, brief intervention, and referral to treatment; protocol implementation; supported diversion). Models varied in their clinical purpose, target population, and care delivery focus. Within each model, differences in aims, context, and implementation resulted in substantial heterogeneity. CONCLUSION:Consultation liaison models provided the most multifaceted care, with a specialist team providing clinical leadership, access to evidence-based interventions, transition to community services, and training of the wider workforce, but rarely described any wider systematic screening for AUD. A consistent observation across all identified models was the limited interface with mental health care, representing a critical gap in current AUD management within general hospitals.

Background Alcohol Assertive Outreach Treatment (AAOT) is an evidence-based model of care for people with alcohol dependence and complex comorbidities. Fidelity to the high-quality model may improve health outcomes yet information is lacking regarding optimal implementation. This study aimed to evaluate the implementation of a new high-quality AAOT service. Method Mixed-methods design comprising quantitative analysis of AAOT service-user data (n = 40), including health outcomes and hospital use; qualitative interviews with nine service-users and three stakeholders; and a focus group with four AAOT staff. Qualitative data were analyzed using Framework Analysis informed by Proctor's Taxonomy of Implementation Outcomes. Results Fidelity to the high-quality AAOT model was achieved. At 6 months, 29.6% of the cohort were abstinent; the remainder showed significant reductions in units of alcohol consumed after 3 months (p = .012). At 6 months, psychological health (p < .001), physical health (p = .039), and quality-of-life (p < .001) had significantly improved, and hospital attendances (p=.019) and admissions (p=.009) significantly decreased. Qualitative analyses indicated participants felt AAOT was acceptable, appropriate, and highlighted facilitators and barriers to service delivery. Conclusions High-quality AAOT services can be successfully implemented into existing services with adequate support, and can achieve high fidelity, and significant benefits to service-users.

Background: In England, alcohol-related hospital admissions exceed 1million per annum. Alcohol care teams (ACT) have evolved in response to this, yet limited generalisable evidence exists about their effectiveness. This study will evaluate the clinical and cost effectiveness of ACT targeting adults with alcohol dependence admitted to NHS Hospitals. Methods: This prospective pragmatic quasi-experimental study will evaluate the effectiveness and cost-effectiveness of ACTs by assessing patient outcomes recruited from three hospitals in England with optimised ACT (oACT) compared to a cohort of participants recruited from similar hospitals with no, or minimal alcohol support (NoACT). N=545 adults (>=18 years) with alcohol dependence admitted (N=245 from three oACT hospitals and N=300 from three NoACT sites) will be recruited. To draw causal inferences of the relative effect of oACTs, a counterfactual control group will be derived, using propensity score matching. We anticipate 70% of participants will be followed up at 6-month (N=175 oACT group; N=210 NoACT (control) group), which allows for a potential unmatched pool in the control group of 20%. The primary outcome measure is total alcohol consumption in the 28 days prior to the 6-month follow-up measured in units of alcohol derived using Timeline Follow Back 28 (TLFB-28). Secondary outcomes include quantity and frequency of substance use in the 28-day period prior to the 6-month assessment, changes in alcohol risk and consequences assessed by Alcohol Use Disorder Identification Test (AUDIT), Severity of Alcohol Dependence Questionnaire (SADQ) and Alcohol Problems Questionnaire (APQ) collected at baseline and at 6-months. Mental health and well-being will be measured at 6-month follow-up using the short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), Personal Health Questionnaire-9 items (PHQ-9) and Generalised Anxiety Disorder assessment (GAD-7). Consent will be requested to access individual health records to calculate the Charlson Comorbidity Index (CCI) at baseline. Economic outcomes will be assessed using the Client Service Receipt Inventory (CSRI) and the cost-effectiveness of oACTs, calculated as the cost per Quality-Adjusted Life Year (QALY) gained compared to control. QALYs will be derived from the EuroQol-5D-5L data. Discussion: Our findings will provide evidence to patients, clinicians, policy makers and commissioners about the best use of NHS funds. Trial registration: ISRCTN10723141. Registration data 1 November 2023

Aims: Cue exposure therapy (CET) is a promising treatment approach for cocaine substance use disorder (SUD). CET specifically targets the psychological and physiological responses elicited by drug-related cues, aiming to reduce their motivational impact. To advance understanding of CET for cocaine treatment, this systematic review aims to categorise the range of cocaine cues used in research. Methods: A systematic review of the existing literature with searches conducted on PubMed and Web of Science bibliographic databases with no time constraints in August 2024 (PROSPERO: CRD42024554361). Three reviewers were independently involved in the screening, review and data extraction process, in line with PRISMA guidelines. Data extracted included participant demographics, study design, data on the cocaine cue task, and examples (if provided). Each study was appraised and received a quality score. The secondary outcome was to summarise examples for each category type identified. The data are presented as a narrative synthesis. Results: 3600 articles were identified and screened. 235 articles were included in the analysis. Cues identified included images, paraphernalia, drug-related words, cocaine smell, auditory stimuli presented via audiotapes, video recordings, scripts, and virtual reality environments, often combining multiple modalities. Included studies recruited cocaine-dependent individuals, recreational users, polydrug users, and non-cocaine-using controls. The sample sizes of the studies ranged from a single case study to a study including 1974 participants. Conclusions: This review found that studies employed a wide range of cue categories, but detailed examples were often lacking, limiting replication. The number and combination of cues varied: some studies used only cocaine-related images, while others included images, videos, physical items, and audiotapes. The level of immersion and personalisation also differed considerably. All studies used cocaine-specific cues, most commonly images or representations of cocaine substance, cocaine use or drug paraphernalia, drug preparation items, or conversations of cocaine use and its effects. The overall quality of the included studies was deemed good, with all adhering to standard research norms. While this review highlights the breath of cue types used in the literature, further research should focus on enhancing cue exposure techniques by incorporating more immersive and personalised stimuli, and by providing clearer documentation of cue characteristics to support replication and clinical translation.

AIMS:To examine predictors of 30-day readmissions to acute hospitals in England for patients treated for alcohol withdrawal (AW). METHODS:Retrospective cross-sectional analysis of routine hospital administrative data (i.e. Hospital Episode Statistics-Admitted Patient Care records) for adults admitted to non-specialist hospitals in England 2017-18. RESULTS:AW admissions were associated with digestive, circulatory, respiratory, and endocrine disorders and were of short duration (median 3 days). Of the 19 588 completed AW admissions examined in 2017-18, 3957 (20.2%) resulted in readmission within 30 days. The strongest predictors of 30-day readmission were being no fixed abode (Adjusted Odds Ratio (AOR) 1.81, 95%CI 1.44-2.26), prior discharge against medical advice (AOR 1.57, 95%CI 1.40-1.77), and greater Charlson comorbidity index total score (AOR 1.02, 95%CI 1.02-1.03). DISCUSSION:AW 30-day admissions are common and associated to complex case presentations that require high levels of community support on discharge. Hospital-based alcohol teams should prioritize strategies, which maximize medically managed AW, effective transitions to specialist community care including outreach teams and strong collaborations with physical and mental health outpatient services. Together with specialist initiatives within community mental health teams, assertive outreach, and homeless services 30-day readmissions may be minimized.

AIMS:This study aimed to identify (i) the number of alcohol care teams (ACTs) in England, (ii) the characteristics of patients supported by ACTs, and (iii) the service structure and care components offered by ACTs. METHODS:All acute hospitals (i.e. those providing short-term high-dependency medical care) in England were approached to complete a survey of alcohol care provision. Surveys were completed through researcher-guided interviews by staff familiar with the hospital's alcohol provision. It featured questions on service structure, patient characteristics, service functions, and policies. Data collection took place between May and October 2023. RESULTS:Of 170 hospitals approached, 122 completed a survey and 80 reported having an ACT. Most ACT patients were male (mean 64.1%; 95% confidence interval (CI) 61.8-66.4), white (mean 79.2%; 95% CI 75.1-83.4), aged 45-54 (mean 27.8%; 95% CI 25.0-30.5), and experiencing severe alcohol dependence (mean 66.2%; 95% CI 36.8-95.7). Most services had a clinical lead but only 58% funded this role. Fifty-nine percent of services operated 7 days per week. Most services reported identification and brief advice, though it was rarely systematized. Nearly all supported medically assisted alcohol withdrawal, though a quarter of patients did not complete medically assisted alcohol withdrawal before discharge. CONCLUSIONS:ACT numbers increased significantly between 2019 and 2024. They offer a clinical service to highly vulnerable and complex patients. There is significant variation in ACT operational models, training, and leadership which will impact the effectiveness of identification strategies and management of patients with comorbid alcohol use disorder within acute medical settings.

Background Alcohol-related liver disease is a common cause of premature death, with higher incidence in the north of England and particularly in areas of high deprivation. Despite this burden of disease, research into liver disease has historically been delivered in other areas of the United Kingdom. THe North of England Alcohol Team (NEAT) research partnership was funded by the NIHR to improve the infrastructure for research into ArLD and in the north of england. Methods NEAT used a variety of methods to bring together stakeholders in ArLD to face-to-face and virtual meetings to identify current barriers to research, possible solutions and research priorities in ArLD. A dedicated public and patient involvement and engagement (PPIE) group was established to support NEAT and future research. An online educational resource was developed. Finally, online workshops including all relevant stakeholders delivered applications for further research funding for specific projects. Results NEAT used a variety of workstreams to achieve its aims. Regional meetings allowed face to face discussion as well as online conversations to identify current barriers to research in ArLD and potential measures to overcome them. Research priorities were confirmed and means to address research barriers were discussed. A PPIE group was convened, and terms of engagement agreed. A virtual research training pack was developed. Research questions were developed, discussed and prepared for future funding applications. We plan to investigate the value of community clinics to improve engagement with liver medicine. Conclusions NEAT brought together a wide range of stakeholders with an interest in improving access to research for people living with alcohol related liver injury. Infrastructure for research was developed including training resources and a PPIE group. This will underpin future research into ArLD in the north of England and more widely.

Abstract Purpose A recent review indicated that physical activity (PA), facilitated by organisations/clubs, may reduce alcohol consumption in early to mid-adolescence. Our study aims were to examine these factors, and identify how health determinants may influence association. Methods Cross-sectional secondary data analysis using UK cohort data from ALSPAC. Ages and sample-size: Time-point (TP) 1: 13-14 (n = 1824), TP2: 15-16 (n = 1334). Variables: minutes per day spent in moderate to vigorous PA > =3 days of accelerometer wear. Ancillary PA variables: Club-type (CT); and frequency of attending club (FAC) collected age 15 only. Risk of alcohol-related harm (RARH) categorised as: no current risk, increasing risk, and at risk (AR). Ordinal regression was conducted at each TP, using PA as a covariate. Explanatory variables (EVs): Psychosocial health (PSH) - Cluster membership numbers generated through K-means cluster analysis (uniquely represented at each TP); Socioeconomic status (SES); Educational attainment; BMI; Smoking status, and Gender. EVs entered into regression model if preliminary X2 tests achieved p Results Regression showed a positive association between PA and RARH at both TPs. Odds of being AR at TP1 were 1.31 greater for each 30 minute increase in PA (95%CI 1.10-1.57; p<0.002). At TP2: OR 1.24 (95%CI 1.01, 1.52; p=.036). TP1: CT (age 15) was not statistically significant at age 13. However, ‘sports club only’ (SCO), had greatest RARH (OR 1.04; 95%CI .806, 1.35; p=.753) vs. no CT. All EVs retained statistical significance at p Conclusions The relationship between PA and alcohol consumption is complex. While facilitated PA can provide many benefits for adolescents, potential unwanted consequences may be an increase in risk-behaviours like alcohol consumption. Further research is needed for greater comprehension of this association.

Background. Opioid dependence is high risk. Opioid agonist treatment (OAT) improves outcomes and reduces deaths. Nonattendance at addiction specialist prescribers who monitor OAT worsens outcomes. Telemedicine has been shown to improve attendance with limited evidence in addictions. Aim. This feasibility trial aimed to assess feasibility for a larger trial assessing attendance, travel, clinical outcomes and satisfaction. Methods. Adult opioid dependent patients prescribed OAT, attending outreach clinics within a United Kingdom community addiction service, were recruited to a feasibility randomised controlled trial of Telemedicine versus Face-to-Face addiction prescriber consultations. Patients were offered two appointments in their randomized group. Follow-up research interviews conducted with patients and staff. Analysis undertaken by SPSS. Results. Fifty-nine opioid dependent patients randomised to Telemedicine (n=29) and Face-to-Face (n=30) consultations. Attendance 76.7% Face-to-Face vs 72.4% Telemedicine (first consultation). Attendance at second consultation lower overall as eighteen of 118 consultations not conducted (COVID-19). One-way travel reduced with Telemedicine by 6.3 Km (first consultation) and 8 Km (second consultation). Clinical outcomes stable between the groups. Follow up high retention (n=58). Both patient (n=58) and staff (n=19) participants reported similar levels of satisfaction for Telemedicine versus Face-to-Face. Conclusions. Patients and staff found Telemedicine satisfactory, with similar attendance rates, clinical outcomes and reduced travel. This is important given COVID-19 changes where telemedicine has been started. Our study shows a large scale RCT is feasible. Limitations include COVID19 impact, more severe dependence and lack of diversity of recruited population.

Objective Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care.Design A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives.Results The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided.Conclusion It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD.

This study aimed to examine characteristics associated with discharge against medical advice from the hospital in alcohol withdrawal patients, supporting the work of hospital staff and Alcohol Care Teams and identifying characteristics that may help target patients most likely to discharge against medical advice. We used Hospital Episode Statistics Data to identify demographic and clinical variables and compare these in alcohol withdrawal patients who discharged against medical advice from hospital, compared with those who were discharged by the clinical team. Factors significantly associated with alcohol withdrawal patients discharging against medical advice from hospital were: being admitted as an emergency; discharged on a weekend; living with no fixed abode; being male; being younger and having a shorter length of stay. This study identifies characteristics that can be used to support acute hospitals and Alcohol Care Teams, particularly in the allocation of resources to reduce discharges against medical advice and subsequent readmissions to the hospital. Particular consideration should be given to clinical provision in hospitals in emergency departments and on weekends, and also those patients who are admitted and are of no fixed abode.

Background:Acamprosate is an effective and cost-effective medication for alcohol relapse prevention but poor adherence can limit its full benefit. Effective interventions to support adherence to acamprosate are therefore needed. Objectives:To determine the effectiveness of Medication Management, with and without Contingency Management, compared to Standard Support alone in enhancing adherence to acamprosate and the impact of adherence to acamprosate on abstinence and reduced alcohol consumption. Design:Multicentre, three-arm, parallel-group, randomised controlled clinical trial. Setting:Specialist alcohol treatment services in five regions of England (South East London, Central and North West London, Wessex, Yorkshire and Humber and West Midlands). Participants:Adults (aged 18 years or more), an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis of alcohol dependence, abstinent from alcohol at baseline assessment, in receipt of a prescription for acamprosate. Interventions:(1) Standard Support, (2) Standard Support with adjunctive Medication Management provided by pharmacists via a clinical contact centre (12 sessions over 6 months), (3) Standard Support with adjunctive Medication Management plus Contingency Management that consisted of vouchers (up to £120) to reinforce participation in Medication Management. Consenting participants were randomised in a 2 : 1 : 1 ratio to one of the three groups using a stratified random permuted block method using a remote system. Participants and researchers were not blind to treatment allocation. Main outcome measures:Primary outcome: self-reported percentage of medication taken in the previous 28 days at 6 months post randomisation. Economic outcome: EuroQol-5 Dimensions, a five-level version, used to calculate quality-adjusted life-years, with costs estimated using the Adult Service Use Schedule. Results:Of the 1459 potential participants approached, 1019 (70%) were assessed and 739 (73 consented to participate in the study, 372 (50%) were allocated to Standard Support, 182 (25%) to Standard Support with Medication Management and 185 (25%) to Standard Support and Medication Management with Contingency Management. Data were available for 518 (70%) of participants at 6-month follow-up, 255 (68.5%) allocated to Standard Support, 122 (67.0%) to Standard Support and Medication Management and 141 (76.2%) to Standard Support and Medication Management with Contingency Management. The mean difference of per cent adherence to acamprosate was higher for those who received Standard Support and Medication Management with Contingency Management (10.6%, 95% confidence interval 19.6% to 1.6%) compared to Standard Support alone, at the primary end point (6-month follow-up). There was no significant difference in per cent days adherent when comparing Standard Support and Medication Management with Standard Support alone 3.1% (95% confidence interval 12.8% to -6.5%) or comparing Standard Support and Medication Management with Standard Support and Medication Management with Contingency Management 7.9% (95% confidence interval 18.7% to -2.8%). The primary economic analysis at 6 months found that Standard Support and Medication Management with Contingency Management was cost-effective compared to Standard Support alone, achieving small gains in quality-adjusted life-years at a lower cost per participant. Cost-effectiveness was not observed for adjunctive Medication Management compared to Standard Support alone. There were no serious adverse events related to the trial interventions reported. Limitations:The trial's primary outcome measure changed substantially due to data collection difficulties and therefore relied on a measure of self-reported adherence. A lower than anticipated follow-up rate at 12 months may have lowered the statistical power to detect differences in the secondary analyses, although the primary analysis was not impacted. Conclusions:Medication Management enhanced with Contingency Management is beneficial to patients for supporting them to take acamprosate. Future work:Given our findings in relation to Contingency Management enhancing Medication Management adherence, future trials should be developed to explore its effectiveness and cost-effectiveness with other alcohol interventions where there is evidence of poor adherence. Trial registration:This trial is registered as ISRCTN17083622 https://doi.org/10.1186/ISRCTN17083622. Funding:This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 22. See the NIHR Journals Library website for further project information.

Background. Telemedicine refers to providing healthcare from one site to another remote site, through information technologies, and has been advocated by the World Health Organisation. Telemedicine has been found to be cost-effective, reducing travel and improving satisfaction as compared to face-to-face appointments. Methods. We assessed patient satisfaction with a new Telemedicine in Addictions service as part of a feasibility randomised controlled trial of telemedicine versus face-to-face consultations (ISRCTN36756455), with addiction specialist prescribers, pre-COVID19. Opioid dependent patients prescribed opioid replacement treatment attending an outreach clinic were recruited. Telemedicine participants completed the NHS Friends and Family Test (FFT) after each consultation. We completed qualitative analysis of the free text responses. Results. Thirty Friends and Family Tests were completed, of which all participants were 'extremely likely' (n=19;67%) or 'likely' (n=11;37%) to recommend Telemedicine. Qualitative analysis themes for recommending telemedicine were 'convenience', 'less travel', 'supportive staff' and 'listened to'. Patients said that everything went well, including communication. Conclusions. Our study found that patients recommend telemedicine because of convenience, less travel, good communication and supportive staff, showing this is acceptable to patients. Due to the COVID-19 pandemic, this technology will be essential for continued access to addiction services.

Introduction Admissions for ArLD continue to rise across the NHS in England. It is estimated up to 60% are in need of specialist interventions on discharge. The interventions often delivered in the community include behavioural, psychological and pharmacological treatments to support alcohol reduction/cessation with the goal of abstinence. National statistics suggest only a 14% are likely to access the care they require following a hospital admission. The review aims to explore patient’s experiences of accessing community alcohol services following a hospital admission. Methods The inclusion criteria comprised of adults (≥18) with a diagnosis of ArLD and a hospital admission. Papers that included patient experiences of accessing community alcohol services were included in the review. All study designs and international studies in English language were included. We searched five databases from 21st September 2021 to 30th September 2021. Data were extracted in a tabular form and a narrative review conducted using thematic synthesis. Results 4,166 papers were identified, 65 papers selected for full text review, six papers were eligible and underwent review and data extraction. Themes Treatment engagement and attendance Patients tended to display higher levels of alcohol abstinence self-efficacy and higher levels of readiness to change. This minimised the perceived need for treatment, with patients feeling they were able to achieve abstinence without support from alcohol community services. Hepatology and psychiatry gap Patients described poor care-coordination between relevant specialties. With patients receiving multiple appointments from a variety of settings with little collaborative care. Self-stigma Self-stigma acted as a barrier to accessing services, with patients feeling shame, embarrassment, societal judgment and undeserving of alcohol support. Patients described fear of labelling. The fear of labelling meant patients felt unable to access community services to avoid the negative connotations associated with labels such as ‘alcoholic’. Social network Patients with a strong social network felt less need to access services, as their social network would provide the alcohol support they require. However, the loss of a social network also acted as motivator to accessing services. Conclusion The experiences of patients accessing community alcohol services varied. The findings are widely person related and service-related issues. Collectively these issues create difficulty in accessing services from a patient’s perspective. The lack of published literature demonstrates little is currently known about the reasons patients do and do not access services particularly in the UK.

BACKGROUND AND AIMS:Alcohol use increases throughout adolescence. Emergency department (ED) attendance is an opportunity for alcohol screening and brief intervention (ASBI), which is effective for adults. This trial evaluated the effectiveness and cost-effectiveness of ASBI compared with screening alone (SA) in high-risk adolescents. DESIGN, SETTING AND PARTICIPANTS:Multi-centre, three-group, single-blind, individually randomized trial with follow-ups after 6 and 12 months in 10 ED settings in England. From October 2014 to May 2015 we screened 3327 adolescents aged 14 to 18 years, of whom 756 (22.7%) scored at least 3 on the Alcohol Use Disorders Identification Test: consumption (AUDIT-C) and consented to participate in this trial. Mean age was 16.1 years; 50.2% were female and 84.9% were white. INTERVENTIONS:Interventions were personalized feedback and brief advice (PFBA), personalized feedback plus electronic brief intervention (eBI) and SA. MEASURES:The primary outcome was the weekly alcohol consumed in standard UK units (8 g ethanol) at 12 months post-randomization, derived from extended AUDIT-C. Economic outcomes included quality of life and service use, from perspectives of both the National Health Service and personal social services (NHS&PSS) and society. FINDINGS:At 12 months, mean weekly consumption was 2.99 [95% confidence interval (CI) = 2.38-3.70] standard units for the SA group, 3.56 (95% CI = 2.90, 4.32) for PFBA and 3.18 (95% CI = 2.50, 3.97) for eBI, showing no significant differences. The PFBA group consumed mean 0.57 (-0.36, 1.70) units more than SA; and eBIs consumed 0.19 (-0.71, 1.30) more. Bayes factors suggested lack of effectiveness explained non-significance. From the NHS&PSS perspective, economic analysis showed that PFBA and eBI were not cost-effective compared with SA: PFBA yielded incremental cost-effectiveness ratio of £6213 (-£736 843, £812 884), with the intervention having 54% probability of being cost-effective compared with SA at the £20 000 WTP threshold. CONCLUSIONS:In emergency departments in England, neither personalized feedback and brief advice nor personalized feedback plus electronic brief intervention showed evidence of being effective or cost-effective when compared with screening alone in reducing alcohol consumption among adolescents.