Alcohol abusers in primary care: readiness to change behavior

Abstract Introduction Alcohol Care Management (ACM) is a manualized treatment provided by behavioral health providers working in a primary care team aimed at increasing patients’ treatment engagement and decreasing their alcohol use. Research has shown that ACM is effective in reducing alcohol consumption; however, the mechanisms of ACM are unknown. Therefore, the purpose of this study is to examine the mechanisms of change in ACM in the context of a randomized clinical trial evaluating the effectiveness of ACM. Materials and Methods This study performed secondary data analysis of existing data from a larger study that involved a sample of U.S. veterans (N = 163) who met criteria for current alcohol dependence. Upon enrollment into the study, participants were randomized to receive either ACM or standard care. ACM was delivered in-person or by telephone within the primary care clinic and focused on the use of oral naltrexone and manualized psychosocial support. According to theory, we hypothesized several ACM treatment components that would mediate alcohol consumption outcomes: engagement in addiction treatment, reduced craving, and increased readiness to change. Parallel mediation models were performed by the PROCESS macro Model 4 in SPSS to test study hypotheses. The institutional review boards at each of the participating facilities approved all study procedures before data collection. Results As hypothesized, results showed that treatment engagement mediated the relation between treatment and both measures of alcohol consumption outcomes, the percentage of alcohol abstinent days, and the percentage of heavy drinking days. Neither craving nor readiness to change mediated the treatment effect on either alcohol consumption outcome. Conclusions Findings suggest that ACM may be effective in changing drinking patterns partially due to an increase in treatment engagement. Future research may benefit from evaluating the specific factors that underlie increased treatment engagement. The current study provides evidence that alcohol use disorder interventions should aim to increase treatment engagement and reduce barriers to care.

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Effects of Group Education by Primary Care Physicians on the Readiness to Change in Heavy Drinkers

Korean Journal of Family Medicine ◽

10.4082/kjfm.2009.30.1.55 ◽

2009 ◽

Vol 30 (1) ◽

pp. 55 ◽

Cited By ~ 1

Author(s):

Sun-Hee Lee ◽

Jong-Sung Kim ◽

Sung-Soo Kim ◽

Jin-Gyu Jung ◽

Chul-Young Lim ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Readiness To Change ◽

Group Education ◽

Heavy Drinkers

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Factors that affect readiness to change lifestyle: A 22-country survey from primary care

European Journal of General Practice ◽

10.3109/13814788.2014.912269 ◽

2014 ◽

Vol 21 (1) ◽

pp. 33-38 ◽

Cited By ~ 7

Author(s):

Mateja Bulc ◽

Igor Švab ◽

Maciek Godycki-Cwirko

Keyword(s):

Primary Care ◽

Readiness To Change

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Mental Health and Readiness to Change Smoking Behavior in Daily Smoking Primary Care Patients

International Journal of Behavioral Medicine ◽

10.1007/s12529-008-9012-6 ◽

2009 ◽

Vol 16 (4) ◽

pp. 347-354 ◽

Cited By ~ 2

Author(s):

Gudrun Schorr ◽

Sabina Ulbricht ◽

Sebastian E. Baumeister ◽

Jeannette Rüge ◽

Janina Grothues ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Readiness To Change ◽

Smoking Behavior ◽

Daily Smoking ◽

Primary Care Patients

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Faculty Development of Pediatric Practitioners: Complexities in Teaching Clinical Precepting

PEDIATRICS ◽

10.1542/peds.97.3.389 ◽

1996 ◽

Vol 97 (3) ◽

pp. 389-393

Author(s):

Kenneth B. Roberts ◽

Thomas G. DeWitt

Keyword(s):

Primary Care ◽

Faculty Development ◽

Role Model ◽

Knowledge And Skills ◽

Change Behavior ◽

Development Course ◽

Over Time ◽

Complex Attention

Community physicians should be ideal role model preceptors for residents to learn office-based primary care. These physicians are the specialists at what they do, just as the organ-based subspecialists are the experts in their field. The faculty development course we developed considered the knowledge, skills, and attitudes necessary for clinical preceptors and attempted to address potential difficulties, such as reservations practitioners might have about accepting the role. It should be axiomatic that once the objectives are defined and are recognized to involve skills and attitudes as well as knowledge, lectures alone (although time-efficient) will not suffice: they are unlikely to change behavior. The key is practice over time, with supervision and reinforcement by respected "experts" and peers. Faculty development for clinical precepting is complex, because clinical precepting, particularly in pediatrics, is complex. Attention to relationships and feelings (anxiety, discomfort, stress) should be built in, along with efforts to improve knowledge and skills.

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