Barriers and facilitators to changing drinking and receiving alcohol-related care: Interviews with Veterans Health Administration primary care patients who indicated interest but did not enroll in an alcohol care management intervention trial

Abstract

Background: Most people with alcohol use disorder do not receive treatment, and primary care (PC)-based management of alcohol use disorder is a key strategy to close this gap. Understanding PC patients’ perspectives on changing drinking and receiving alcohol-related care is important for this goal, particularly among those who decline alcohol-related care. This study examined perspectives on barriers and facilitators to changing drinking and receiving alcohol-related care among Veterans Health Administration (VA) PC patients who indicated interest but did not enroll in the Choosing Healthier drinking Options In primary CarE trial (CHOICE), which tested a PC-based alcohol care management intervention. Methods: VA PC patients with frequent heavy drinking who indicated interest in CHOICE but did not enroll were invited to participate. Twenty-seven patients completed in-person, semi-structured interviews. Interview transcripts were analyzed using iterative deductive and inductive content analysis. Results: Participants were mostly men (96%) and White (59%), and the mean age was 48. Seventy-four percent met criteria for alcohol use disorder, and the median number of past-week standard drinks was 41.5. Participants reported fewer alcohol-related problems, lower importance of/readiness to change drinking, and higher confidence in their ability to change than patients who enrolled in the CHOICE trial. Barriers fell into 5 domains: drinking fulfills need(s); reducing drinking or treatment is not needed; treatment is not effective/not acceptable; alcohol-related stigma; and practical barriers. Facilitators fell into 4 domains: reasons to change drinking; social support; treatment is acceptable/meets patients’ needs; and practical facilitators. Participants discussed how Veteran identity and military experiences impacted drinking and willingness to receive care, which amplified multiple barriers/facilitators. Conclusions: This study identified barriers and facilitators to changing drinking and receiving alcohol-related care among VA PC patients who indicated interest but did not enroll in an alcohol care management trial. Findings can inform patient-centered interventions and support clinicians in engaging patients in care.

Keywords:

• Alcohol use disorder
• alcohol treatment
• primary care
• Veterans Health Administration
• qualitative

Acknowledgments

The authors thank the patients who participated in the interviews, as well as Rachel Thomas, Erika Holden, and Selin Caka for their support of recruitment and data collection for this study.

Author contributions

MF led the development of the analytic approach, analyses, interpretation of findings, and manuscript writing. TM contributed to the development of the analytic approach, analyses, interpretation of findings, and reviewing/editing of the manuscript. JR contributed to the development of the analytic approach, interpretation of findings, and reviewing/editing of the manuscript. AL contributed to study conceptualization, data collection, development of the analytic approach, interpretation of findings, and reviewing/editing of the manuscript. CA contributed to the interpretation of findings and reviewing/editing of the manuscript. KB led study conceptualization and contributed to the development of the analytic approach, interpretation of findings, and reviewing/editing of the manuscript. EW contributed to study conceptualization, development of the analytic approach, interpretation of findings, and reviewing/editing of the manuscript.

Disclosure statement

None of the authors report a conflict of interest. The opinions expressed in this work are the authors’ and do not necessarily reflect those of the institutions, funders, the Department of Veterans Affairs, or the United States Government. Preliminary findings from this study were presented at the 2019 Addiction Health Services Research Conference.

Additional information

Funding

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (grant numbers R01AA018702, 3R01AA018702-04S1). Ms. Frost and Ms. Matson are supported by predoctoral training awards from the Veterans Affairs (VA) Puget Sound Research and Development Service. Dr. Bradley was supported by a mid-career mentorship award from the National Institute on Alcohol Abuse and Alcoholism at the time of this study (grant number K24 AA022128). In-kind support was provided by VA Puget Sound Center of Excellence in Substance Addiction Treatment and Education and VA Puget Sound Health Services Research and Development. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.