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Open Access Highly Accessed Research article

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

Nicolas Bertholet12*, Nicholas J Horton3 and Richard Saitz145

Author Affiliations

1 Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA

2 Clinical Epidemiology Center, Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland

3 Department of Mathematics and Statistics, Smith College, Northampton, Massachusetts, USA

4 Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, Massachusetts, USA

5 Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA

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BMC Public Health 2009, 9:101  doi:10.1186/1471-2458-9-101

Published: 9 April 2009



The course of alcohol consumption and cognitive dimensions of behavior change (readiness to change, importance of changing and confidence in ability to change) in primary care patients are not well described. The objective of the study was to determine changes in readiness, importance and confidence after a primary care visit, and 6-month improvements in both drinking and cognitive dimensions of behavior change, in patients with unhealthy alcohol use.


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.