Often, primary care clinicians inadequately address alcohol use with their patients.

To describe alcohol-related discussions in primary care, investigators audiotaped and performed qualitative analysis of outpatient visits involving 14 primary care clinicians (physicians and nurse practitioners) and 29 of their patients.

All patients were male veterans who screened positive for unhealthy alcohol use.*

Three themes emerged:

• Patients often disclosed that they consumed large amounts of alcohol and/or experienced negative health consequences from drinking.
  
  
• Clinicians commonly responded by changing the subject, minimizing the significance of their patients' drinking, or pursuing a nonalcohol-related issue.
  
  
• Hesitation, stuttering, inappropriate laughter, and ambiguous statements were apparent when clinicians discussed alcohol but not other topics.
  Advice about drinking was tentative and vague while advice about smoking was more common, decisive, and specific.

Comments by Peter D. Friedmann, MD, MPH:
Brief alcohol counseling -- an evidence-based practice -- has been poorly disseminated into primary care practice. This exploratory study suggests that clinicians' discomfort and limited skills in assessing and advising patients with unhealthy alcohol use are partly to blame.

Although training alone is not sufficient to increase alcohol counseling, these findings indicate that educational initiatives to improve primary care clinicians' comfort levels and skills are necessary, nonetheless.

*Reported drinking >=14 drinks per week or >=5 drinks per occasion, scored >=1 point on the CAGE questionnaire, or reported ever having a drinking problem

Reprinted with permission from Alcohol and Health: Current Evidence.