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Prim Care Companion CNS Disord. 2019 Nov 14;21(6). pii: 19m02497. doi: 10.4088/PCC.19m02497.

Barriers to and Facilitators of Delivering Brief Tobacco and Alcohol Interventions in Integrated Primary Care Settings.

Wray JM1,2,3,4, Funderburk JS3,5,6, Gass JC3,7, Maisto SA3,5.

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Mental Health Service 116, Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401.
Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA.
VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York, USA.
Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Psychology, Syracuse University, Syracuse, New York, USA.
Department of Psychiatry, University of Rochester, Rochester, New York, USA.
Department of Psychology, University at Buffalo, Buffalo, New York, USA.



Tobacco and excessive alcohol use are 2 of the top 3 preventable causes of death in the United States, yet most patients using these substances do not pursue treatment. Most patients do visit their primary care provider (PCP) annually, but PCPs report that they are not very effective in addressing behavior change with patients. Brief interventions for alcohol and tobacco use are effective and can be delivered by behavioral health providers (BHPs) embedded in the primary care setting. However, BHPs do not report frequent use of these interventions. The aim of the current study was to conduct the first examination of barriers to and facilitators of implementing brief interventions for at-risk drinking and tobacco use among integrated BHPs.


BHPs (N = 285) working in a primary care setting for at least 6 months with at least 10% effort allocated to clinical activities were recruited through professional listservs (August-September 2016) and completed an online survey that assessed barriers to and facilitators of delivering brief tobacco and alcohol interventions in routine clinical practice.


BHPs were primarily psychologists (48%) and social workers (33%) with cognitive-behavioral orientation (51%). The primary barriers to addressing tobacco use and at-risk drinking reported by BHPs was the perception that patients did not want to discuss or did not want to change these behaviors. The primary facilitators of addressing tobacco use and at-risk drinking were patients identifying cessation or reduction as a treatment goal, positive provider-patient relationship, and receiving referrals specifically for tobacco or alcohol use.


Clinicians, researchers, and administrators should focus on strategies to increase the regularity with which BHPs assess and provide intervention for smoking and alcohol use in the context of other primary presenting concerns.

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