title: Readiness to change in primary care patients who screened positive for alcohol misuse.
abstract: OBJECTIVE
  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 > or =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 chi2 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.
authors.affiliation: Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Wash 98101, USA. emwilli@u.washington.edu
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.forename: Carol E
authors.initials: CE
authors.lastname: Achtmeyer
authors.forename: Kinsey A
authors.initials: KA
authors.lastname: McCormick
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000523:psychology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D003717:Denial, Psychological; D015438:Health Behavior; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009042:Motivation; D011320:Primary Health Care; D014728:Veterans / Q000523:psychology