Alcohol Screening Instruments
Engaging women at risk of having a child with FASD in brief (5 to 10 minute) counselling sessions can reduce alcohol consumption during pregnancy by up to 30%.
Screening and brief interventions need to be embraced as standards of care.
There is strong evidence for the effectiveness of brief collaborative, motivational interviewing approaches for reducing the risk of women having an alcohol exposed pregnancy. In fact, a service provider who takes an empathetic, collaborative approach is one of the strongest predictors of whether a woman will be able to change.
According to research published in Prevention of Fetal Alcohol Spectrum Disorder FASD –Who is Responsible? (Institute of Health Economics, 2011), “screening programs for prenatal use of alcohol have proven effective in identifying high-risk women, and there is strong evidence of the effectiveness of several types of intervention in reducing alcohol use during pregnancy.”
The Canadian guidelines for diagnosis of FASD recommend screening all pregnant and post-partum women for alcohol use. Such screening can improve maternal/child health outcomes through early identification and reduction of problem maternal drinking, early identification of exposed infants, and earlier diagnosis of FASD.
Level II Screening: Structured Questionnaires
If a woman indicates that she does consume alcohol, then a second stage of screening is necessary. This can be done using standardised screening questionnaires. Practitioners can also use this opportunity to help a pregnant woman who is using alcohol with a “brief intervention” in the office. There are numerous methods for structured screening. Those that are validated in women of reproductive age and used widely by Canadian practitioners.
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According to new studies, even low levels of prenatal alcohol exposure can negatively affect the developing fetus, thereby increasing the importance of identifying women who drink during pregnancy. In response, researchers have developed several simple alcohol-screening instruments for use with pregnant women. These instruments, which can be administered quickly and easily, have been evaluated and found to be effective. Because of the potential adverse consequences of prenatal alcohol exposure, short screening questionnaires are worthwhile preventive measures when combined with appropriate follow-up.
The screening instruments, the T-ACE and TWEAK were tested in diverse clinical populations and may help identify women using alcohol during pregnancy. These instruments vary in that they were designed to detect different levels of alcohol use and, therefore, differ in how they define pregnancy risk drinking.
In general, a positive screen does not indicate an alcoholism diagnosis; rather, it may signal to a physician or other health care practitioner the need to discuss pregnancy risk drinking with a patient. Routine use of screening questionnaires in clinical practices may reduce the stigmatization of asking patients about alcohol use and result in more accurate and consistent evaluation.
Floyd, R.L., et al., Preventing Alcohol Exposed Pregnancies: A Randomized Control Trial. American Journal of Preventive Medicine, 2007. 32(1): p. 1-10.
Miller, W.R. and S. Rollnick, Motivational Interviewing: Preparing People for Change. 2nd ed. 2002, New York, NY: The Guilford Press.