How Primary Care Providers Talk to Patients about Alcohol

A Qualitative Study

Although brief primary care alcohol counseling has been shown to benefit patients with alcohol misuse and providers generally believe that addressing alcohol misuse is an important clinical responsibility, rates of alcohol counseling are low. This qualitative study analyzes audiotaped alcohol-related discussions between primary care providers and patients and identifies major themes. Participants in the study included 29 male outpatients at a Veteran's Affairs General Internal Medicine Clinic who screened positive for alcohol misuse and their 14 primary care providers, all of whom were participating in a larger quality improvement trial. Patients were unaware of the study's focus on alcohol-related issues. Three major themes emerged from the patient visits in which alcohol was discussed.

  1. Patients disclosed information regarding their alcohol use, but providers often did not explore these disclosures, even in some cases where patients attempted to reinitiate an alcohol-related discussion.
  2. Advice offered to patients about alcohol use was typically vague and/or tentative in contrast to smoking-related advice.
  3. Discomfort on the part of the provider was evident during alcohol-related discussions.

These findings suggest that provider discomfort and avoidance may be significant barriers to discussions about alcohol use in primary care. Patient behaviors in the study suggested that patients are willing to engage in dialogue about their drinking with a primary care provider, but the study indicates that providers may not be prepared to offer such counseling. The authors conclude that there may be a need for educational programs aimed at increasing provider comfort and effectiveness with this important role.