One of the main challenges to identifying a group of at-risk pregnant alcohol users is to effectively screen for alcohol use and related problems using reliable methods. Several short questionnaires currently exist that have been used to screen for problematic alcohol use and have been evaluated in multiple settings. Of these screening tools, the two that have been used most effectively with pregnant women are the T-ACE and the TWEAK. The tool shown to be effective with adolescents is the CRAFFT. The screening questions can be presented orally during interview or the woman can fill them out while waiting to meet with you.

T-ACE14 T- TOLERANCE, How many drinks does it take to make you feel high? [3 or more drinks constitutes a positive answer = 2 points] A- Have people ANNOYED you by criticizing your drinking? ["yes" constitutes a positive answer = 1 point] C- Have you ever felt you ought to CUT DOWN on your drinking? ["yes" constitutes a positive answer = 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" constitutes a positive answer = 1 point] A positive screen is a score of 2 or more points.

TWEAK15 T-TOLERANCE How many drinks does it take before you begin to feel the first effects of alcohol? [3 or more drinks constitutes a positive answer = 2 points] W- WORRY Do close friends or relatives worry or complain about your drinking? ["yes" constitutes a positive answer = 2 points] E-EYE OPENER Do you sometimes take a drink in the morning when you first get up? ["yes" constitutes a positive answer = 1 point] A-AMNESIA Has a friend or family member ever told you about things you said or did when you were drinking that you could not remember? ["yes" constitutes a positive answer = 1 point] K-CUT DOWN Do you sometimes feel the need to cut down on your drinking? ["yes" constitutes a positive answer = 1 point] Scores on the TWEAK range from 0 to 7. Investigators have suggested that a cut point total score on the TWEAK of 2 or more should be used to optimize sensitivity/specificity in identifying pregnant women who may not be alcohol dependent but who may, nevertheless, be drinking at levels that place the fetus at risk.

CRAFFT16 C- Have you ever ridden in a CAR driven by someone (including yourself) who was high or had been using alcohol or drugs? R- Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? A- Do you ever use alcohol or drugs while you are by yourself, ALONE? F- Do you ever FORGET things you did while using alcohol or drugs? F- Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use? T- Have you ever gotten into TROUBLE while you were using alcohol or drugs? Each question on the CRAFFT is given a score of 1. The authors recommend that any positive answer on the CRAFFT be followed by further inquiry and possible brief intervention.

select your preferred media type for viewing     Quicktime .MOV format (5.0 MB)     Windows Media .WMV format (1.7 MB)     MP4 format for iPods and other portable players (1.7 MB)

Polina reports that it takes 5-6 drinks for her to feel the effects of alcohol. Her mother is worried about her alcohol consumption. She does not drink alcohol in the morning, she has had blackouts in the past but not in the past year, she thinks that maybe she should cut down on her drinking now that she knows she is pregnant.

Exercise: Compute Polina's TWEAK score
Answer: click here to view answer