FEEDBACK AND RESPONSIBILITY "You have already done many good things to help your baby be healthy. You mentioned that you are having ____drinks on occasion. Did you know that there is no safe amount of drinking when you are pregnant because alcohol exposure can hurt a developing baby. No one can make you decide to change your drinking. What you do about your drinking is up to you. But you can have a healthier baby if you stop drinking now. A baby who has been exposed to alcohol during pregnancy might have some problems."
MAJOR PROBLEMS: Small Size, Mental Retardation, Facial Deformities, Heart Problems
OTHER PROBLEMS: Eating and Sleeping, Hyperactivity and Inattention, Language Delays, Memory and Learning, Hearing and Vision, Social Problems, Motor Delays

ADVICE TO CHANGE "The best advice for a pregnant woman is to not drink any alcohol."

Ask for a response to your advice to make sure the patient understands the need to take action: "What do you think about what I have just said? Would you like to work with me to quit or reduce your drinking?"

MENU OF WAYS TO REDUCE DRINKING-RISKY SITUATIONS
"People drink for different reasons. Here are some examples of risky situations for some people: At a party, On weekends, Following arguments, When feeling uptight or stressed, When feeling angry, When smoking, When friends are drinking, When feeling sad, Wanting to fit in. Are there situations in which you feel like you want to drink?"

MENU OF WAYS TO REDUCE DRINKING-DEALING WITH RISKY SITUATIONS
"It is important to figure out how you can resist drinking in risky situations. Here are some examples of ways in which people cope with a desire to drink: Go for a walk, Call a friend, Grab a snack, Listen to music. Can you tell me some ways you think you can avoid drinking in these risky situations?"

ESTABLISHING A DRINKING GOAL
"Now, thinking about how much alcohol you have told me that you drink, would you like to set a drinking goal? Would you like to stop or lower your alcohol use? A reasonable goal for someone who is pregnant is abstinence Ð not drinking any alcohol. I know that some people find that total abstinence is difficult. What would you like to do? What goal would you like to set for yourself? Stop drinking altogether or cutting down?"

SET YOUR GOAL: Encourage abstinence. Agree on number of drinks per week.

SELF EFFICACY
"On a scale of 1 to 5, how sure are you that you can stop (lower) your drinking? 1 means you think you CANNOT stop (cut down) your drinking and 5 means you are sure you CAN stop (cut down) your drinking."

Add water to hard liquor (whiskey, rum, gin)
Drink no more than one drink per hour
Eat food when you drink
Sip your drinks
Do not drink from the bottle
Drink water or juice instead of alcohol
Do not drink 3 or more drinks per drinking occasion

ENCOURAGEMENT AND FOLLOW UP

Changing one's behavior can be hard. It will become easier.
Remember your drinking goal
Some people have days when they drink too much. If this happens to you, DO NOT GIVE UP
At the end of each week, think about how many days you did not drink and congratulate yourself
Your follow up visit is important. Please remember to come see me.