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(i) To evaluate the effect of receiving one of two brief interventions in reducing alcohol consumption among general hospital patients compared with usual care. (ii) To assess whether a brief intervention of self-efficacy enhancement was superior to a self-help booklet in reducing alcohol consumption.A three-arm cluster randomized controlled trial.Seven general medical, six general surgical, one dermatology and two otolaryngology wards of a large teaching hospital covering a large urban and rural area.A total of 215 of 789 in-patients aged 18–75 years, who screened positive for alcohol consumption in excess of national recommended limits according to a 7-day retrospective drinking diary.Participants were allocated to receive one of three interventions: (i) face-to-face self-efficacy enhancement; (ii) a self-help booklet; or (iii) usual care.The primary outcome measure was change in reported alcohol consumption at 6-month follow-up as measured by a 7-day retrospective drinking diary. Secondary outcomes were change in: number of alcohol drinking days in last week; the maximum units of alcohol consumed on any one day in last week; and Drinking Refusal Self-efficacy Expectancy Questionnaire score.Compared to the usual care group the self-efficacy enhancement group (−10.1 units 95% CI −16.1 to −4.1) and the self-help booklet group (−10.0 units 95% CI −16.0 to −3.9) had greater reductions in self-reported weekly alcohol consumption. There was no evidence that self-efficacy enhancement was superior to the self-help booklet (P = 0.96).Brief interventions delivered in hospital offer simple means of helping heavy drinkers to reduce their alcohol consumption.