Screening women of child-bearing age and pregnant women and recording their alcohol consumption is a practical process to identify women at risk and potentially exposed infants. Based on the information gathered during screening, a practitioner can tailor interventions and refer patients to appropriate health and other community resources.
Practitioners are encouraged to screen at least annually and early in pregnancy. The following three levels of screening are successive steps in a structured approach to screening:
Level I screening involves practice – based approaches such as motivational interviewing and supportive dialogue
Level II screening includes a number of structured questionnaires with indirect or masked screening (T-ACE, TWEAK) or directed questioning (TLFB)
Level III screening includes laboratory based tools
Level I Screening: Practice-based Screening
Recent surveys of health professionals indicate that some clinicians feel uncomfortable asking about alcohol use. They may avoid the subject entirely because they do not know how to identify women who engage in at-risk drinking without embarrassing or offending women who aren’t consuming alcohol. Others lack knowledge of the available alcohol treatment and counselling services, or they practise in areas that simply lack adequate services. Still others may hesitate to screen because they are pressed for time and screening for alcohol use may seem to be beyond the scope of their practice.
Notably, though, asking one or two interview questions concerning alcohol use has proven effective in screening women and identifying those who are drinking and in need of education or intervention.
For the practitioner who chooses to use the single question method, the following questions are effective for establishing a rapport and beginning a conversation about alcohol use:
- When was the last time you had a drink?
- Do you ever enjoy a drink or two?
- Do you sometimes drink beer, wine or other alcoholic beverages?
- Do you ever use alcohol?
- In the past month or two, have you ever enjoyed a drink or two?
If a woman indicates she does not consume alcohol, then positive reinforcement is beneficial. Research shows it is helpful to provide brochures and other information about a healthy lifestyle during pregnancy, including details about alcohol abstinence and the effects of alcohol on the fetus. Any written information should be linguistically and culturally sensitive.