Action toward Change Predicts Reduced Alcohol Consumption among Unhealthy Drinkers, but Recognition of the Problem Does Not

Counseling patients regarding substance use includes an assessment of their readiness to change, which involves both recognition of the problem and either taking action or making a commitment to change. In this prospective cohort study, the authors analyzed data from 267 hospitalized patients with unhealthy drinking recruited for a randomized controlled trial of a brief intervention to determine the association between readiness to change and subsequent alcohol use. Seventy-eight percent of subjects met criteria for alcohol dependence. Readiness to change was measured by 3 methods: visual analog scale (VAS) and Perception of Problem (PP) and Taking Action (TA) scores from the Stages of Change Readiness and Treatment Eager ness Scale (SOCRATES). The primary outcome, assessed at 3 months, was average number of drinks per day in the past 30 days. Multivariable analysis was used to adjust for other factors.

• Those in the highest tertile of VAS-measured readiness drank significantly less than those in the lowest tertile.

• Those with PP scores in the 3rd quartile drank significantly more than those in the lowest quartile. Patients in the second and highest quartiles also drank more, but the difference was not significant.

• Those with TA scores in the highest quartile drank significantly less than those in the lowest quartile.

Comments:

This study shows that readiness to change (in particular, taking action) is associated with improved outcomes among unhealthy drinkers, while recognition of the problem is associated with poorer outcomes and likely reflects the severity of the problem. Although the study included all patients with unhealthy drinking, the majority were alcohol dependent; thus, the results may not be applicable to nondependent unhealthy drinkers. These findings suggest that, when counseling patients, clinicians should focus on their commitment to making concrete behavioral changes rather than their perception of the problem. Darius A. Rastegar, MD

Reference:

Bertholet N, Cheng DM, Palfai TP, et al. Does readiness to change predict subsequent alcohol consumption in medical inpatients with unhealthy alcohol use? Addict Behav. 2009;34(8):636–640.