Managing Unhealthy Alcohol Use in Primary Care

Doctor and patient are discussing something, just hands at the table.

Problem

Unhealthy alcohol use remains a major public health challenge insufficiently addressed in primary care.

Unhealthy alcohol use is a leading cause of preventable death and is associated with a wide range of adverse consequences related to physical and mental health, and social and economic concerns. Despite the serious public health impact of unhealthy alcohol use and the demonstrated effectiveness of screening and brief intervention (SBI) and medication treatment, these evidence-based approaches are not implemented as part of routine practice in primary care settings.

The Agency for Healthcare Research and Quality (AHRQ) launched this initiative to advance a more patient-centered health care system by strengthening behavioral health integration in primary care. Through its PCOR initiative, AHRQ invests in scaling evidence-based quality improvement strategies that increase screening, management, and treatment of unhealthy alcohol use using SBI and medication treatment. Recognizing the persistent implementation gap, AHRQ sought to understand how primary care practices can adopt, integrate, and sustain effective alcohol screening and intervention workflows. Strengthening these practices supports national goals to reduce substance-related harms and directly aligns with NORC’s mission to improve public health through evidence-based research, implementation support, and applied evaluation.

Solution

NORC evaluated and assisted six AHRQ-funded grantees who supported primary care practices in implementing evidence-based alcohol screening and interventions.

Under AHRQ’s PCOR initiative, NORC was contracted to support the implementation of evidence-based strategies for addressing unhealthy alcohol use in primary care. NORC developed and managed the Managing Unhealthy Alcohol Use Resource Center, which served as a centralized hub for shared learning, technical assistance, and access to implementation tools. Through the Resource Center, NORC convened a learning community of grantees, facilitated a technical expert panel, and conducted an ongoing environmental scan. The Resource Center also provided primary care practices and grantees with access to more tools and resources through AHRQ’s Academy for Integrating Behavioral Health and Primary Care.

In addition, NORC conducted a rigorous mixed-methods, multisite evaluation of six AHRQ-funded grantees working with hundreds of primary care practices. The evaluation assessed recruitment and retention, dissemination and implementation strategies, practice-level outcomes, and sustainability. Together, the Resource Center and evaluation activities demonstrated NORC’s strengths in implementation support, behavioral health integration, stakeholder engagement, and applied evaluation—helping practices strengthen their capacity to identify and address unhealthy alcohol use.

Result

NORC’s work strengthened implementation capacity and advanced understanding of the barriers, facilitators, and strategies that impact implementation.

NORC’s Resource Center and evaluation activities enhanced primary care practices’ ability to integrate evidence-based alcohol screening, brief intervention, and medication treatment into routine workflows. Through the Resource Center, grantees accessed a curated library of more than 450 tools and implementation resources, as well as shared learning opportunities that supported consistent, high‑quality SBI delivery. NORC also disseminated findings and implementation lessons through a final report and a public webinar, which expanded the reach of insights generated across participating primary care sites.

Findings from NORC’s mixed-methods multisite evaluation identified factors associated with successful implementation—such as workflow redesign, practice facilitation, leadership engagement, and effective use of health IT. These lessons informed AHRQ’s ongoing Managing Unhealthy Alcohol Use Initiative, helping advance national efforts to strengthen behavioral health integration. NORC’s work provided AHRQ, grantees, and primary care practices with actionable knowledge to sustain and spread evidence-based approaches to addressing unhealthy alcohol use.