Most Alcohol Abusers Ready to Change Their Ways

SEATTLE, May 31 - The stereotypic image of alcohol abusers denying their problems, and showing no inclination to change their ways, is wrong in most cases, according to researchers here.

A large cross-sectional analysis of data collected from male outpatients at seven Veterans Affairs general medicine clinics indicates that most men with an alcohol problem recognize the fact and are at least willing to think about changing their behavior, according to Emily Williams, M.P.H., of the VA Puget Sound Health Care System here.

The finding has implications for clinicians, Williams and colleagues reported in the May/June issue of Annals of Family Medicine, especially because primary care physicians sometimes expect patients to deny misusing alcohol. This attitude may be a barrier to conducting brief alcohol counseling interventions among patients with alcohol misuse.

"Such denial is often thought to be especially common among patients with the most severe problems, indicative of alcohol dependence," Williams and colleagues said.

However, analysis of data collected from 6,419 men showed that the opposite appears to be true - that those with the highest level of severity of alcohol misuse were most likely to be thinking about or actively changing their drinking behavior, the researchers said.

As part of the VA Ambulatory Care Quality Improvement Project (ACQUIP), more than 62,000 patients at the seven centers were mailed a health checklist, which included the CAGE Questionnaire, a validated alcohol misuse screening tool, as well as four additional questions about alcohol consequences and previous problem drinking.

Patients who returned the checklist and were positive for alcohol problems were mailed another survey, this one including the 10-item Alcohol Use Disorders Identification Test (AUDIT) and three readiness-to-change questions. Male respondents who reported drinking in the past year were included in the study. Female respondents were few and were excluded.

More than half the initial sample returned the first health checklist, and of those 11,889 (36%), were positive for alcohol misuse. Again, more than half of those 11,889 completed the subsequent alcohol-specific survey, or about 10% of the original sample.

The World Health Organization suggests breaking scores on the AUDIT into four "severity zones" - less than eight, eight to 15, 16 to 19, and 20 or greater - with alcohol counseling recommended for patients whose AUDIT score is eight or greater but less than 20.

Of the 6,419 eligible participants, the researchers said, 36% had an AUDIT score of eight or greater.

According to their responses to the three readiness-to-change questions, 25% had not thought about changing their drinking habits or didn't think they drank too much, 24% were contemplating change or at least thought they drank too much, and 51% had already cut down or stopped drinking.

Among patients with AUDIT scores greater than eight, the researchers noted, more than 90% said they drank more than they should and had thought about drinking less, indicating a readiness to change their behavior. In fact, Williams and colleagues found, greater readiness to change was significantly associated with greater severity of alcohol misuse (at P