Elsevier

Addictive Behaviors

Volume 30, Issue 2, February 2005, Pages 389-395
Addictive Behaviors

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A brief readiness to change drinking algorithm: Concurrent validity in female VA primary care patients

https://doi.org/10.1016/j.addbeh.2004.05.015Get rights and content

Abstract

Brief primary care interventions for alcohol use should be tailored to patients' readiness to change; however, validated measures of readiness to change are too lengthy to be practical in most primary care settings. We compared a readiness to change drinking algorithm (RTC Algorithm) based on three standardized questions to a validated 12-item readiness to change questionnaire (Rollnick RTCQ) in 85 hazardous drinking female Veterans Affairs (VA) patients. Results from comparisons of mean Rollnick RTCQ scale scores across RTC Algorithm categories suggest good concurrent validity. Regular assessment using the RTC Algorithm questions may help primary care providers tailor alcohol-related discussions with hazardous drinking patients.

Introduction

In 1982, Prochaska and DiClemente described a model of change specifically intended for use in behavior change therapy. Since then, a number of instruments have been developed to measure readiness to change for a variety of risk behaviors, including alcohol consumption (Carey, Purnine, Maisto, & Carey, 1999). Several of these have been shown to predict outcomes after alcohol treatment Heather et al., 1993, Isenhart, 1997. Measure of readiness to change drinking may also be useful in primary care settings for tailoring brief alcohol counseling with patients who screen positive for hazardous or problem drinking (Samet & O'Connor, 1998). Primary care providers may be more likely to counsel patients about alcohol use if they are aware of their patients' own concerns about their drinking.

Only one measure of readiness to change, the Rollnick Readiness to Change Questionnaire or RTCQ, has been developed specifically for general medical settings (Rollnick, Heather, Gold, & Hall, 1992). The Rollnick RTCQ was designed to measure three dimensions of readiness to change (Rollnick et al., 1992), and predicts change over time in alcohol consumption (Heather et al., 1993). The 12-item questionnaire's length makes the Rollnick RTCQ difficult to incorporate into routine primary care practice. Although briefer readiness to change algorithms have been developed and used in a variety of settings, they are based on information gathered during unstructured assessments, making them difficult to interpret and evaluate (Carey et al., 1999). Therefore, a brief standardized measure of readiness to change drinking for primary care settings would be useful.

In 1993, based on a review of available literature and face validity, three readiness to change drinking questions were developed for use in self-administered surveys (Bradley, McDonell, Stanfeld, & Fihn, 1994). Three pieces of information were considered important for counseling patients about their drinking: (1) Does the patient recognize that his/her drinking may be a problem? (2) Is the patient interested in changing his/her drinking? and (3) Has the patient recently changed his/her drinking? In the present study, these same readiness to change drinking questions (Fig. 1) and the 12-item Rollnick RTCQ were administered to female Veterans Affairs (VA) patients as part of a study of alcohol screening tests. The purpose of this report is to describe a scoring algorithm (RTC Algorithm) based on three readiness to change drinking questions and evaluate its concurrent validity using the Rollnick RTCQ as a comparison standard.

Section snippets

Methods

This study is based on data collected as part of the Veteran Women's Alcohol Problems Study conducted at VA Puget Sound Health Care System in 2000. Women were eligible for an interview study if they resided in Washington State and had received care at VA Puget Sound. Of 2548 eligible women, 393 (15%) completed the in-person Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS; Grant, Harford, Dawson, Chou, & Pickering, 1995) and a preinterview self-administered

Results

Of the 393 female VA patients who completed the AUDADIS interview and preinterview questionnaire, 85 (22%) met NIAAA criteria for past-year hazardous drinking and completed both RTC measures. The study sample was mostly over 40 (M=42 years, S.D.=11), white (78%), married (51%), and reported some college or technical training (69%). Thirty-five (41%) hazardous drinkers also met DSM-IV criteria for an alcohol disorder. Mean Rollnick RTCQ scale scores in the study population (N=85) were as

Discussion

In this sample of female VA patients who met criteria for past-year hazardous drinking, the three RTC Algorithm questions appear to identify dimensions of readiness to change drinking similar to those of the validated Rollnick RTCQ. Over 95% of participants in the contemplation or action categories based on the Rollnick RTCQ were also categorized as contemplation or action based on the RTC Algorithm. Of patients who indicated some readiness to change on the RTC Algorithm, only 42% were

Acknowledgements

This research was supported by a grant from the Department of Veteran's Affairs, Health Services Research and Development Service (GEN 97-022). A. Epler is currently supported by a training grant (T32 #AA13526-01) from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Dr. Bradley is currently supported by a K23 Career Development Award (#AA00313) from NIAAA and is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar.

References (10)

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1

Previously at Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA.

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