Alcohol abusers in primary care: readiness to change behavior

PURPOSE: Assessing readiness to address alcohol problems is an important early step in managing the alcohol abusing patient. We assessed readiness for behavioral change in primary care of patients who screen positive for alcohol abuse based on the CAGE questionnaire. Our hypothesis was that these patients would be predominantly in the contemplation stage, an opportune stage for physicians to facilitate their movement into substance abuse treatment. PATIENTS AND METHODS: We administered the CAGE questionnaire, a well-validated screening tool for detecting alcohol abuse, to 1,211 of 1,335 patients (91%) who attended two urban primary care clinics. Patients who responded positively to one or more CAGE questions were administered two validated instruments that assessed readiness to change alcohol use. We also measured quantity and frequency of alcohol use. RESULTS: Seventeen percent of patients gave a positive response to one or more CAGE questions (209 of 1,211) and were eligible for further evaluation; 92% (192 of 209) agreed to participate. These subjects’ mean age was 50 years and the majority (58%) were African American. Of these patients, 23% were in the precontemplative (denial) stage, 14% were in the contemplative stage, and 63% were in the action stage of behavior change, indicating that they were in early or long-term recovery. Stage of readiness to change results were similar for those with one positive response and two or more positive responses to CAGE questions. CONCLUSIONS: Most patients in whom alcohol abuse is detected in primary care using the CAGE questionnaire are either actively addressing their substance abuse or are in recovery. Contrary to our hypothesis, only a minority of patients are in the contemplation stage. Assessment of stage of change is not apparent from the CAGE questionnaire alone. Our results suggest that clinical skills to facilitate relapse prevention would be particularly valuable for clinicians addressing alcohol abuse in the primary care setting.