Author's response to reviews Title: Improvements in readiness to change and drinking in primary care patients with unhealthy alcohol use: a prospective study Authors:

Abstracts must be structured into Background, Methods, Results, Conclusions. Please remember to also update the Abstract details on the submission page. Background: The course of alcohol consumption and cognitive dimensions of behavior change (readiness to change, importance of changing and confidence in ability to change) in primary care patients are not well described. The objective of the study was to determine changes in readiness, importance and confidence after a primary care visit, and 6-month improvements in both drinking and cognitive dimensions of behavior change, in patients with unhealthy alcohol use. Methods: Prospective cohort study of patients with unhealthy alcohol use visiting primary care physicians, with repeated assessments of readiness, importance, and confidence (visual analogue scale (VAS), score range 1-10 points). Improvements 6 months later were defined as no unhealthy alcohol use or any increase in readiness, importance, or confidence. Regression models accounted for clustering by physician and adjusted for demographics, alcohol consumption and related problems, and discussion with the physician about alcohol. Results: From before to immediately after the primary care physician visit, patients (n=173) had increases in readiness (mean +1.0 point), importance (+0.2), and confidence (+0.5)(all p<0.002). In adjusted models, discussion with the physician about alcohol was associated with increased readiness (+0.8, p=0.04). At 6 months, many participants had improvements in drinking or readiness (62%), drinking or importance (58%), or drinking or confidence (56%). Conclusions: Readiness, importance and confidence improve in many patients with unhealthy alcohol use immediately after a primary care visit. Six months after a visit, most patients have improvements in either drinking or these cognitive dimensions of behavior change. Conclusions Please insert a Conclusions section after the Discussion. We recommend including a Conclusions heading above the paragraph which beings `In conclusion¿¿ We inserted the requested heading Reference 33 ¿ please provide full details for this reference. This means for an Article providing volume/issue/page numbers and for a book the publisher/city. We updated the reference: 33. Miller WR, Tonigan J, Longabaugh R. The Drinker Inventory of Consequences (DrInC). An Instrument for Assessing Adverse Consequences of Alcohol Abuse. Test Manual. Bethesda: National Institutes of Health publication; 1995. Reference 47 ¿ please provide full details for this reference. This means for an Article providing volume/issue/page numbers and for a book the publisher/city. We updated the reference: 47. Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Annu Rev Clin Psychol 2008;4:1-32. Tables Please do not include vertical lines in your tables. We deleted the vertical lines Minor revisions (We can make these changes on resubmission, although it will speed up publication of your manuscript if you do them while making the major changes above). Title Please use sentence case in the title, both in the manuscript file and the submission system i.e. remove all unnecessary capitals (capitalise only the first word, and proper nouns, and no full stops/periods). For example you would change `The Title of My Prestigious Publication: A Scientific Study¿. To `The title of my prestigious publication: a scientific study¿ The title is now in the requested casse Qualifications Please remove the authors' qualifications (e.g. PhD / MD) from the manuscript and submissions system Email address please include email addresses for all the authors on the title page. Please use the following formatGSF: [email protected] HS: [email protected] SE: [email protected] We removed authors qualifications and added e-mailaddresses Keywords, Word-counts ¿ Please remove these. We removed these Introduction Please rename this section `Background¿. The introduction section was renamed Please move the Acknowledgements section to after the Authors' contributions and prior to the Reference list. We move the section