BMC Public Health Research article Improvements in readiness to change and drinking in primary care patients with unhealthy alcohol use: a prospective study Nicolas Bertholet*1,2, Nicholas J Horton3 and Richard Saitz1,4,5 BioMed Central Open Access Address: 1Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA, 2Clinical Epidemiology Center, Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland, 3Department of Mathematics and Statistics, Smith College, Northampton, Massachusetts, USA, 4Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, Massachusetts, USA and 5Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA Email: Nicolas Bertholet* - nberthol@bu.edu; Nicholas J Horton - nhorton@email.smith.edu; Richard Saitz - rsaitz@bu.edu * Corresponding author Published: 9 April 2009 BMC Public Health 2009, 9:101 doi:10.1186/1471-2458-9-101 This article is available from: http://www.biomedcentral.com/1471-2458/9/101 Received: 17 September 2008 Accepted: 9 April 2009 © 2009 Bertholet et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: 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. Methods: 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. Results: 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%). Conclusion: 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. Background Unhealthy alcohol use (the spectrum from at-risk drink- ing amounts through alcohol dependence) and its conse- quences 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 Page 1 of 9 (page number not for citation purposes)