KA Bradley MD MPH, Northwest Health Services Research and Development Center of Excellence; Primary and Specialty Medical Care Service, VA Puget Sound Health Care System; Departments of Medicine and Health Services, University of Washington; JL Sporleder BS, Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System; DR Kivlahan PhD, Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System; Department of Psychiatry and Behavioral Sciences, University of Washington; M Burman MD MPH, Northwest Health Services Research and Development Center of Excellence; Primary and Specialty Medical Care Service, VA Puget Sound Health Care System; Departments of Medicine, University of Washington; MB McDonell MS, Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System; SD Fihn MD MPH, Northwest Health Services Research and Development Center of Excellence; Primary and Specialty Medical Care Service, VA Puget Sound Health Care System; Departments of Medicine and Health Services, University of Washington

Objectives: Little is known about the alcohol treatment history of VA primary care patients who screen positive for at-risk drinking, and it's relationship to alcohol-related consequences and readiness to change drinking. We examined the prevalence of previous alcohol treatment and compared rates of past-year alcohol-related consequences and readiness to change drinking between at-risk drinkers who reported previous alcohol treatment and those who did not.

Methods: As part of the Ambulatory Care Quality Improvement Project (ACQUIP), all General Internal Medicine patients at 7 VA sites were sent screening questionnaires that included previously validated screening questions for at-risk drinking: a 7-item augmented CAGE questionnaire and a question about episodic heavy drinking. All patients who screened positive for at-risk drinking were mailed a Drinking Practices Questionnaire (DPQ) that included the Alcohol Use Disorders Identification Test (AUDIT), the question "Have you ever been in treatment or attended AA meetings for an alcohol problem?" and a question about readiness to change drinking. For this cross-sectional analysis, we used the first DPQ returned by at-risk-drinking patients enrolled during Year 1 of the trial. Patients were excluded who did not complete the question about alcohol treatment and 3 AUDIT questions about symptoms of alcohol dependence. We used the augmented CAGE and the AUDIT to identify alcohol-related consequences in the past-year.

Results: Of 4,946 eligible at-risk drinkers who returned Drinking Practices Questionnaires, 211 reported alcohol treatment in the past year and were excluded from analyses because it was unknown if their survey responses represented before or after alcohol treatment. Of the 4,735 remaining at-risk drinkers, 1,015 (21.4%) reported previous alcohol treatment, and 3,720 (78.6%) reported no alcohol treatment. Of previously treated, at-risk drinkers, only 49 (4.8%) reported no alcohol-related consequences in the past year; 527 (51.9%) had AUDIT scores >= 8 (mean 10.5), and 407 (40.1%) reported one or more symptom(s) of dependence in the past year. In contrast, among those with no previous alcohol treatment, 944 (25.4%) reported no past year alcohol-related consequences, 891 (23.9%) had AUDIT scores >= 8 (mean 5.3), and only 515 (13.8%) reported past year symptom(s) of dependence (all p values <0.0005). Previously treated at-risk drinkers more often indicated readiness-to-change drinking than untreated at-risk drinkers (81.4% vs. 64.3%; OR=2.6; 95%CI 2.2-3.1). This relationship persisted (OR=1.7; 1.4-2.0) after adjusting for the severity of at-risk drinking using the AUDIT score.

Conclusions: Over 20% of VA general medical patients who reported at-risk drinking, also reported previous alcohol treatment. An additional 4.3% had treatment in the past year. Among patients who self-reported at-risk drinking in the past year and reported previous alcohol treatment, almost all reported adverse consequences due to drinking in the past year, and over 80% reported readiness to change their drinking.

Impact: Among VA general medical patients who report past-year at-risk drinking, the 20% who report previous alcohol treatment are a high-risk population that may benefit from special attention. Tailored services for previously treated at-risk drinkers could be provided in primary care clinics or in specialized addictions treatment units