Alcohol Screening and Brief Intervention

1 in 13 women reports drinking alcohol during pregnancy, which can cause fetal alcohol spectrum disorders (FASDs). Learn about ways to reduce risky drinking.

CDC recently reported that 1 in 8 women and 1 in 5 high school girls binge drink¹, increasing their risk of breast cancer, heart disease, sexually transmitted infections, and unintended pregnancy. CDC also reports that 1 in 13 women drink during pregnancy², increasing their risk of miscarriage, stillbirth, and a range of lifelong disorders in their babies known as fetal alcohol spectrum disorders (FASDs).

FASDs are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. FASDs are completely preventable if a woman does not drink alcohol while pregnant.

How Dr. Benson Uses Alcohol Screening and Brief Intervention

As an obstetrician-gynecologist, Dr. Benson³ routinely asked her patients about their alcohol use. “I took their answers at face value and, like many doctors, I believed that using alcohol in pregnancy or excessively drinking alcohol wasn’t something my patients did.” But national estimates tell a different story.

To help doctors like Dr. Benson identify patients who drink alcohol at risky levels⁴ and get them the help they need, CDC is promoting alcohol screening and brief intervention through its FASD Regional Training Centers. Over thirty years of research has shown that alcohol screening and brief intervention is effective at reducing risky drinking. Based on this evidence, the U.S. Preventive Services Task Force and many other organizations have recommended that alcohol screening and brief intervention be implemented for all adults in primary health care settings. It is a preventive service like high blood pressure or cholesterol screening. It identifies and helps patients who might be drinking too much. Alcohol screening and brief intervention involves a set of validated questions to identify patients’ drinking patterns, a short conversation with patients who drink too much, and referral to treatment as needed.

CDC’s FASD Regional Training Centers have been training medical and allied health students and practitioners in the prevention, identification, and care of FASDs since 2002. It was around then that Dr. Benson first became involved. More recently, the training centers are moving beyond training of alcohol screening and brief intervention. They are working to integrate this vital intervention into clinical practice and evaluate feasibility and uptake in multiple primary care systems, including family medicine, women’s health, student health, and public health clinics.

Dr. Benson explains that after her initial training in the program, she began asking every patient at every visit about alcohol use. She followed through with additional questions regarding frequency, amount, and type of alcohol use. “In doing so, I elicited histories of alcohol use I would have otherwise never known: the woman who split a case of beer with her spouse every Friday and Saturday night; the woman who poured out her guilt over her drinking pattern and her fear that alcohol had affected her child; and the newly pregnant patient who was a recovering alcoholic,” she said. “There is no doubt that CDC’s training has impacted my daily medical practice.”

For Dr. Benson, though, the training hit closer to home. She said that something about the content really spoke to her. She assumed it was an underlying commitment to education and practice. But as she sat in a refresher session the following year, she realized that the content was describing her son. She and her pediatrician knew his birth mother had used alcohol during pregnancy, but had never connected that to his small head, growth delays, and learning issues. Suddenly it all fell into place and his diagnosis of fetal alcohol syndrome (FAS) was confirmed by a doctor in the training program. “And so began my personal journey with FASDs,” she said.

Dr. Benson is committed to reaching other obstetrician-gynecologists and women’s health care providers with this intervention and important messages about risky drinking. “Risky drinking is a problem and it leads to so many more problems for women and their families,” she said. “As a mother and a doctor, I’m privileged to be involved in this effort to help other doctors address this under-recognized problem.”

Resources for Health Professionals

Women and Alcohol
This website from the American College of Obstetricians and Gynecologists provides resources for women’s health care providers that can be used to identify women who drink too much and offer them brief intervention to reduce or eliminate alcohol use. It also has links to resources and information for the public.

Medscape Video – Alcohol and Women: How to Screen and Intervene
In this CDC Expert Commentary in partnership with Medscape, Dr. Joe Sniezek discusses steps that health care providers can take to detect and intervene with women who drink alcohol at risky levels. Advice is based on guidance from the American College of Obstetricians and Gynecologists.

CHOICES Curriculum [344 KB]
CHOICES: A Program for Women About Choosing Healthy Behaviors is an intervention for non-pregnant women of childbearing age and is designed to prevent alcohol-exposed pregnancies by addressing risky drinking and ineffective or no use of contraception. The CHOICES curriculum is designed for use by professionals trained in behavioral health counseling who will be conducting the CHOICES program. It includes a facilitator guide, counselor manual, client workbook, and a training DVD with videos demonstrating components of the intervention. To order, visit www.cdc.gov/fasd and click on “Free Materials.”

American Academy of Pediatrics (AAP) FASD Toolkit
This comprehensive toolkit serves as the framework for the medical home management of a child with an FASD, providing tools and resources for primary care providers to be better equipped to meet the special needs of these children and families.

Training & Education
Find training and educational resources for health care providers. Learn more about CDC’s FASD Regional Training Centers.

FASD App
A free app on alcohol use during pregnancy and FASDs for your iPhone, iPod Touch, or iPad – check it out!

How to Find Help in Your Area

Are you looking for local services for diagnosis or intervention for individuals with FASDs, support groups for families, or alcohol treatment for women? The National Organization on Fetal Alcohol Syndrome (NOFAS) offers an online directory of services available in each state. Click on your state in the NOFAS National Resource Directory.

References

1. In this report, binge drinking for women is defined as four or more drinks on an occasion. Binge drinking for high school girls is defined as having had five or more drinks of alcohol in a row (within a couple of hours) on at least one day during the 30 days before the survey.
   Source: Vital Signs: Binge Drinking Among Women and High School Girls – United States, 2011
2. Defined as at least one drink of any alcoholic beverage during the 30 days before the survey.
   Source: Alcohol Use and Binge Drinking Among Women of Childbearing Age – United States, 2006–2010
3. Name has been changed for the purpose of privacy.
4. Also referred to as alcohol misuse, or excessive, unhealthy, hazardous, or harmful drinking.