In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training & support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCU) in different locations throughout Catalonia, England, Netherlands, Poland and Sweden. Our interventions were training & support and financial reimbursement to providers. Our design was a randomized factorial trial with baseline measurement period, 12-week implementation period, and nine-month follow-up measurement period. Our outcome measures were: attitudes of individual providers in working with drinkers as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and, the proportion of consulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was associated with more positive attitudes. Training & support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudes through its impact on higher intervention activity. We conclude that to improve primary health care providers screening and brief advice activity for heavy drinking requires a combination of training & support and on the job experience of actually delivering screening and brief advice activity.