Perceptions of Patients' Alcohol Use and Related Problems Among Primary Care Professionals in Rio de Janeiro

Alcohol screening and brief intervention in primary care reduce harmful alcohol use but are rarely conducted in Brazil. This study describes health professionals' perceptions of patients' harmful alcohol use. A modified grounded theory approach drawing on purposive sampling was used to secure interviews from thirty-three primary care professionals between September and November 2018. Data analysis was iterative; initial coding was developed by the full research team and refined using formative and axial coding. Alcohol symptomology varied and professionals associated harmful alcohol use with patients' economic hardship. Although health professionals rarely identified alcohol-related problems among their patients, when alcohol problems were identified, it was often through consultations about other symptoms. Compared to drug use, low to moderate alcohol use was not considered harmful, supported in part by a widespread acceptance of alcohol use. Brazil's universal primary care system uses a collaborative care model to support integrated treatment of medical and mental health conditions, but alcohol screenings often occur only after problems manifest. Given limited early identification of harmful alcohol use in primary care, it is necessary to improve professionals' training related to alcohol screening and brief intervention to reduce alcohol-related disability-adjusted life years.