Improvements in readiness to change and drinking in primary care patients with unhealthy alcohol use: a prospective study

Prospective cohort study of patients with unhealthy alcohol use visiting primary care physicians, with repeated assessments of readiness, importance, and confidence (visual analogue scale (VAS), score range 1–10 points). Improvements 6 months later were defined as no unhealthy alcohol use or any increase in readiness, importance, or confidence. Regression models accounted for clustering by physician and adjusted for demographics, alcohol consumption and related problems, and discussion with the physician about alcohol.From before to immediately after the primary care physician visit, patients (n = 173) had increases in readiness (mean +1.0 point), importance (+0.2), and confidence (+0.5) (all p < 0.002). In adjusted models, discussion with the physician about alcohol was associated with increased readiness (+0.8, p = 0.04). At 6 months, many participants had improvements in drinking or readiness (62%), drinking or importance (58%), or drinking or confidence (56%).Readiness, importance and confidence improve in many patients with unhealthy alcohol use immediately after a primary care visit. Six months after a visit, most patients have improvements in either drinking or these cognitive dimensions of behavior change.Unhealthy alcohol use (the spectrum from at-risk drinking amounts through alcohol dependence) and its consequences represent a major burden of disease in the general population [1,2]. Among those with unhealthy alcohol use, brief intervention (BI) and motivational interviewing have demonstrated evidence of efficacy [3-5]. In primary care, BI is recommended by national practice guidelines (US Preventive Services Task Force, 2004), and, as part of BI, clinicians are encouraged to assess motivation and readiness to change, and to help patients increase readiness [6]. These changes in readiness are seen as short term goals on the way to decreased consumption [7,8].Processes of change have been conceptualized in various ways; in the Transtheoretical model, Proch