ALCOHOL ABUSERS IN PRIMARY-CARE - READINESS TO CHANGE BEHAVIOR

PURPOSE: Assessing readiness to address alcohol problems is an importa nt early step in managing the alcohol abusing patient. We assessed rea diness for behavioral change in primary care of patients who screen po sitive for alcohol abuse based on the CAGE questionnaire. Our hypothes is 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 urba n primary care clinics. Patients who responded positively to one or mo re CAGE questions were administered two validated instruments that ass essed readiness to change alcohol use. We also measured quantity and f requency of alcohol use. RESULTS: Seventeen percent of patients gave a positive response to one or more CAGE questions (209 of 1,211) and we re eligible for further evaluation; 92% (192 of 209) agreed to partici pate. These subjects' mean age was 50 years and the majority (58%) wer e African American. Of these patients, 23% were in the precontemplativ e (denial) stage, 14% were in the contemplative stage, and 63% were in the action stage of behavior change, indicating that they were in ear ly or long-term recovery. Stage of readiness to change results were si milar for those with one positive response and two or more positive re sponses to CAGE questions. CONCLUSIONS: Most patients in whom alcohol abuse is detected in primary care using the CAGE questionnaire are eit her actively addressing their substance abuse or are in recovery. Cont rary to our hypothesis, only a minority of patients are in the contemp lation stage. Assessment of stage of change is not apparent from the C AGE questionnaire alone. Our results suggest that clinical skills to f acilitate relapse prevention would be particularly valuable for clinic ians addressing alcohol abuse in the primary care setting. (C) 1998 by Excerpta Medica, Inc.