title: Brief Intervention for Heavy Drinking in Primary Care: Role of Patient Initiation.
abstract: BACKGROUND
  Alcohol brief intervention (BI) in primary care (PC) is effective, but remains underutilized despite multiple efforts to increase provider-initiated BI. An alternative approach to promote BI is to prompt patients to initiate alcohol-related discussions. Little is known about the role of patients in BI delivery.
  
  
  OBJECTIVE
  To determine the characteristics of PC patients who reported initiating BI with their providers, and to evaluate the association between the initiator (patient vs provider) and drinking after a BI.
  
  
  METHODS
  In the context of clinical trial, patients (n = 267) who received BI during a PC visit reported on the manner in which the BI was initiated, readiness to change, demographics, and recent history of alcohol consumption. Drinking was assessed again at 6-months after the BI.
  
  
  RESULTS
  Fifty percent of patients receiving a BI reported initiating the discussion of drinking themselves. Compared with those who reported a provider-initiated discussion, self-initiators were significantly younger (43.7 years vs 47.1 years; P = 0.03), more likely to meet Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for current major depression (24% vs 14%; P = 0.04), and more likely to report a history of alcohol withdrawal symptoms (68% vs 52%; P < 0.01). Baseline readiness to change, baseline consumption rates, and current DSM-IV alcohol dependence were not different between groups. In the 2 to 3 weeks after BI, self-initiators reported greater decreases in drinks per week (5.7 vs 2.4; P = 0.02), and drinking days per week (1.0 vs 0.3; P = 0.002). At 6-month follow-up, self-initiators showed significantly greater reductions in weekly drinking compared to those whose provider initiated the BI (P = 0.002).
  
  
  CONCLUSIONS
  Patient- and provider-initiated BI occurred with equal frequency, and patient-initiated BIs were associated with greater reductions in alcohol use. Future efforts to increase the BI rate in PC should include a focus on prompting patients to initiate alcohol-related discussions.
authors.affiliation: Department of Psychiatry (GLR, SEG, JEH), Department of Medical Biostatistics (GJB), and Department of General Internal Medicine (DAP), University of Vermont, College of Medicine, Burlington, VT; and Department of Preventive Medicine and Public Health (TLF), University of Kansas School of Medicine, Kansas City, KS.
authors.forename: Gail L
authors.initials: GL
authors.lastname: Rose
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Guth
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Badger
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Plante
authors.forename: Tera L
authors.initials: TL
authors.lastname: Fazzino
authors.forename: John E
authors.initials: JE
authors.lastname: Helzer
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods*; D012648:Self Care; D055815:Young Adult