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The key to the prevention of fetal alcohol syndrome is to screen all women of childbearing age for alcohol use disorders in order to identify those at risk, and then use appropriate counseling techniques to reduce or eliminate drinking before pregnancy.
Brief intervention has been found to be effective with women problem drinkers in primary-care clinics. A brief, 10-minute counseling session delivered by a clinician has been found to reduce alcohol use in women by 20-30 percent.
The CDC has identified characteristics associated with a higher risk of alcohol use during pregnancy based on cross-sectional survey data and special populations. Factors include having a history of physical or sexual abuse, being a smoker, being unmarried, having a history of previous or current illicit drug use, having psychological stress, having mental health disorders, low socioeconomic status, African-American and American-Indian/Alaska-Native ethnicity. Additionally, other factors include a family history of substance abuse.
The National Center for Education in Maternal and Child Health has produced a set of guidelines for screening for a substance abuse during pregnancy. Their guidelines can be found at http://www.ncemch.org/pubs/PDFs/SubAbuse.pdf.
Over the past decade, much research has gone in to refining techniques for screening pregnant women for alcohol use. To view links to publications assessing some of the most effective instruments, click here!
What follows is a useful guide to screening for substance abuse during pregnancy. Click on the instrument of choice for the list of specific questions.
Instrument |
Features |
Strengths |
Concerns |
CAGE
Cut down
Annoyed
Guilty
Eye Opener |
4 questions, not specifically designed for screening pregnant women. |
Assess lifetime rather than current alcohol related problems. |
Does not identify heavy drinker who have not experienced alcohol related problems. More effective in screening men than women. |
T-ACE
Tolerance-
Annoyed
Cut down
Eye Opener
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4 questions, one question regarding how many drinks to feel high, three questions from CAGE. |
Developed for use in Ob/Gyn practice. More sensitive to risk drinking than CAGE. |
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TWEAK
Tolerance
Worry
Eye Opener
Amnesia
Cut-Down |
5 questions, combines questions from the MAST, CAGE, & T-ACE |
More sensitive and less specific than the T-ACE. Out performs the MAST or CAGE. |
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MAST
Michigan
Alcoholism
Screening
Test |
25 questions, not specifically designed for screening pregnant women |
|
Does not identify heavy drinkers who have not experienced alcohol related problems. More effective in screening men. |
AUDIT
Alcohol
Use
Disorder
Identification
Test |
10 questions, combines questions about alcohol use directly and on consequences of alcohol use |
Its purpose is the early identification of harmful drinking. |
Not been evaluated in obstetric population. |
4 P's
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4 questions about alcohol or drug use during current pregnancy, in her past, by her partner, and by her parents |
Yes or No format, easy to administer and score. |
Potential lack of specificity. |
Modified 5P’s
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5 questions, about alcohol or drug use during this pregnancy, by her parents, by her partner, in her past, in her previous pregnancy. |
Questions about alcohol use during previous pregnancy may help to diagnose FAS in woman’s other children. |
Potential lack of specificity. |
TQDH
Ten
Question
Drinking
History |
10 questions that focus on type and amount of alcohol consumed. |
Does not differentiate between beer, wine and liquor. |
More than 4 drinks per week is considered risk drinking. Best for women not yet pregnant. |
Citation: Morse B, Gehshan S, Hutchins E. 1997. Screening for a Substance Abuse During Pregnancy: Improving Care, Improving Health. Arlington, VA: National Center for Education in Maternal and Child Health.
The National Institute on Alchol Abuse and Alcoholism has released updated guidelines for primary care physicians and mental health specialists:
Helping Patients Who Drink Too Much: A Clinician's Guide 2005
http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf
Referring Patients to Treatment
Women also respond to guided self-change programs based on cognitive behavioral therapy models. These programs are for motivated women who want to reduce their use or become abstinent. They generally are limited to four to 10 one-hour sessions with a counselor.
A number of clinical trials have shown reduced alcohol use in alcohol-dependent persons after completion of an alcohol treatment program. While there is still a great deal we do not know about treatment of women with alcohol use disorders, brief intervention, guided self-change programs, cognitive therapy, behavioral therapy and the 12-step program can be effective. Other issues to consider in specialized treatment for women are the availability of child care, transportation, gender-specific programs and the treatment of comorbidity, such as other substance abuse and mental health disorders.
To locate a drug and alcohol abuse treatment program near you, click here for the Substance Abuse Treatment Facility Locator, created by the Substance Abuse & Mental Health Services Administration.
Recently, the U.S. Preventive Services Task Force released recommendations for alcohol misuse in clinical settings. To view the recommendations and guides for screening, go to
http://www.ahrq.gov/clinic/uspstf/uspsdrin.htm
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