Chronic pain and alcohol use commonly co-occur and are associated with considerable functional impairment. Many patients with chronic pain present to primary care, and integrated primary care may be well-suited to provide brief, behaviorally focused treatment. Little is known about behavioral health treatment barriers and preferences among primary care patients with chronic pain and alcohol use. Veterans enrolled in Veterans Health Administration primary care with a chronic musculoskeletal pain diagnosis and past-year alcohol use were identified via electronic medical record review and mailed a survey with measures of alcohol use, pain severity/interference, treatment preferences, and treatment barriers. Chi-square tests were used to identify statistically significant treatment preferences. Generalized linear models tested for differences in treatment barriers based on alcohol risk, and pain severity was tested as a moderator using the PROCESS macro in SPSS. Patients expressed preferences for individual, face-to-face treatment in primary care. Participants reported they were overall receptive to behavioral health treatment, with the exception of treatment for alcohol, tobacco, or other drug use. Differences based on alcohol risk were observed for readiness to change alcohol use and beliefs about the relationship between pain and alcohol. Pain severity was a significant moderator of the relationships between alcohol risk and pain readiness, beliefs about pain and alcohol, and overall alcohol treatment barriers. Treatment preferences were largely aligned with models of integrated primary care. The impact of barriers on treatment engagement may vary by a patient's degree of alcohol-related risk, and thus a range of treatment options should be considered. (PsycInfo Database Record (c) 2025 APA, all rights reserved).