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Readiness to Change in Primary Care Patients Who Screened Positive for Alcohol Misuse

¹ Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Wash
² Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Wash
³ Department of Medicine, School of Medicine, University of Washington, Seattle, Wash
⁴ Departments of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Wash
⁵ Clinical Addiction Research and Education Unit, Department of Medicine, Boston University School of Medicine, and Boston Medical Center, Boston, Mass
⁶ Youth Alcohol Prevention Center and Department of Epidemiology, Boston University School of Public Health, Boston, Mass
⁷ Harborview Medical Center, Seattle, Wash
⁸ Primary and Specialty Medical Care Service, VA Puget Sound Health Care System, Seattle, Wash
⁹ Department of Health Services, University of Washington, Seattle, Wash

CORRESPONDING AUTHOR: Emily C. Williams, MPH, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, emwilli{at}u.washington.edu

PURPOSE Readiness to change drinking may influence the content or effectiveness of brief alcohol counseling. This study was designed to assess readiness to change and its relationship to alcohol misuse severity among primary care patients whose screening questionnaire was positive for alcohol misuse.

METHODS This study was a cross-sectional analysis of data collected from 2 consecutive mailed questionnaires. Male outpatients at 7 Veterans Affairs (VA) general medicine clinics were eligible if they returned both questionnaires, screened positive for alcohol misuse (augmented CAGE Questionnaire 1 point), responded to 3 readiness-to-change questions, and completed the Alcohol Use Disorders Identification Test (AUDIT). A validated algorithm based on 3 standardized questions categorized participants into 3 readiness groups (precontemplation, contemplation, action). Measures of alcohol misuse severity included AUDIT, CAGE, and the 3 consumption questions from the AUDIT (AUDIT-C). Analyses were descriptive; linear-by-linear associations between alcohol misuse severity and readiness were tested with ² statistics.

RESULTS Response rates to the first and second surveys were 59% and 55%, respectively. Of the 6,419 eligible outpatients who screened positive for alcohol misuse, 4,797 (75%) reported any readiness to change (contemplation 24%, action 51%). Among patients with AUDIT scores >8, more than 90% indicated that they drank more than they should and/or had contemplated drinking less. Greater readiness was significantly associated with greater alcohol misuse severity (P <.001 for all measures).

CONCLUSIONS Most primary care patients who screen positive for alcohol misuse indicate some readiness to change. Contrary to stereotypes of denial, those with greater alcohol misuse severity are more likely to report readiness to change.

Key Words: Alcohol drinking • alcoholism/diagnosis • patient acceptance of health care

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