A tailored practice facilitation support strategy was associated with increased uptake of evidence-based screening and advice on unhealthy alcohol use in adults in small and medium-sized primary care practices. This strategy represents an improvement in the quality of care. Meta-analyses have confirmed the effectiveness of brief interventions to reduce drinking in primary care patients with unhealthy alcohol use identified by routine screening. Among 6210 patients with follow-up alcohol screening, 1751 (28%) patients received a brief intervention. At follow-up screening, unhealthy alcohol use was resolved in 2922 (47%) patients. Patients with documented brief intervention were older and more likely to have other substance use disorders, mental illness, poor health, and more severe unhealthy alcohol use. Routine alcohol screening and brief intervention for patients with a positive screening is a prevention priority.