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    Screening
     
    What is the role of the provider?
    • The American Congress of Obstetricians and Gynecologists recommends that providers identify women with at-risk drinking habits, engage in brief intervention and education, and refer patients to professional treatment as needed1   
            Screening all women for alcohol use yearly
            Screening pregnant women during the first trimester
    • Despite recommendations for universal screening, women remain less likely than men to be screened for at-risk alcohol use2
    • In Maryland, up to 30% of pregnant women reported that they never received alcohol counseling during prenatal care3
    • Only 1 in 6 adults in the U.S. reports discussing alcohol use with a health professional4
     
    TACE
    • TACE was the first screening tool developed and validated for use in pregnant women.  It takes less than one minute to complete5 
    T – Tolerance
    How many drinks does it take to make you feel high?
    (More than 2 drinks = 2 points)
    A – Annoyed
    Have people annoyed you by criticizing your drinking?
    (Yes  = 1 point)
    C – Cut down
    Have you ever felt you ought to cut down on your drinking?
    (Yes = 1 point)
    E – Eye opener
    Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
    (Yes = 1 point)
    SCORING - A score of 2 points or more indicates a positive screen for at-risk drinking
     
    AUDIT-C
    • AUDIT-C is a modified version of a longer screening tool called AUDIT, which was developed by The World Health Organization.  It was originally developed and validated for use in primary care settings6 
     
    How often do you have a drink containing alcohol?
    a. Never     b. Monthly or less        c. 2-4 times a month    d. 2-3 times a week     e. 4 or more times a week
    (a = 0 points, b = 1 point, c = 2 points, d = 3 points, e = 4 points)
    How many standard drinks containing alcohol do you have on a typical day?
    a. 1 or 2     b. 3 or 4           c. 5 or 6           d. 7 to 9           e. 10 or more
    (a = 0 points, b = 1 point, c = 2 points, d = 3 points, e = 4 points)
    How often do you have six or more drinks on one occasion?
    a. Never     b. Less than monthly   c. Monthly       d. Weekly        e. Daily or almost daily
    (a = 0 points, b = 1 point, c = 2 points, d = 3 points, e = 4 points)
    SCORING - A score of 3 points or more indicates a positive screen for at-risk drinking
     
    Single Question Screening Test
    • The single question-screening test was developed by and is recommended by The National Institute on Alcohol Abuse and Alcoholism.  It has been validated for use in primary care settings.
    How many times in the past year have you had 4 or more drinks in a day?
     
     

    SCORING - An answer of 1 or more indicates a positive screen for at-risk drinking

     

     
    Resources
    1. American College of Obstetricians and Gynecologists. (2011). ACOG committee opinion 496: At-Risk Drinking and Alcohol Dependence: Obstetric and Gynecologic Implications. Washington, DC: American College of Obstetricians and Gynecologists.
    2. American College of Obstetricians and Gynecologists. (2008). ACOG committee opinion 422: At-Risk Drinking and Illicit Drug Use: Ethical Issues in Obstetric and Gynecologic Practice.  Washington, DC: American College of Obstetricians and Gynecologists.
    3. Maryland PRAMS: Focus on Alcohol Use and Binge Drinking.  Available at: www.marylandprams.org
    4. CDC Morbidity and Mortality Weekly Report, January 7, 2014, Vital signs: Communication between health professionals and their patients about alcohol use – 44 states and the District of Columbia, 2011
    5. Chang, G. Alcohol-screening Instruments for Pregnant Women. Retrieved January 15, 2014 from The National Institute on Alcohol Abuse and Alcoholism Web site: http://pubs.niaaa.nih.gov/publications/arh25-3/204-209.htm.
    6. Screening Tools.  Retrieved January 15, 2014 from The Substance Abuse and Mental Health Services Administration Web Site: http://www.integration.samhsa.gov/clinical-practice/screening-tools#drugs
    7. Smith, P.C. et al. (2009). Primary care validation of a single-question alcohol-screening test. J Gen Intern Med 24. 783-788.
     
     
    January, 2014