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Brief Addiction Screening

TWEAK     T-ACE     Alcohol & Drug Assessment Questionnaire

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Posted On: May 4, 2001          Updated On: May 04, 2002
© Terence T. Gorski, 2001

Brief Screening Test:  TWEAK

<Read It On Charlotte Kasl's Women At Risk Website>
Charlotte Kasl, Many Roads, One Journey: Moving Beyond the 12 Steps. 
Charlotte Kasl, P.0. Box 1302, Lolo MT 59847

Do you drink alcoholic beverages? If you do, please take our "TWEAK Test."

T

Tolerance: How many drinks does it take to make you feel high? (Record number of drinks)

Score 2 points if she reports 3 or more drinks to feel the effects of alcohol. Score:____

No. of drinks

____

W

Worry: Have close friends or relatives worried or complained about your drinking in the past year?

Score 2 points for a positive "yes". Score:____

____Yes

____ No

E

Eye-Opener: Do you sometimes have a drink in the morning when you first get up?

Score 1 point for a positive "yes". Score:____

____Yes

____ No

A

Amnesia (Blackouts): Has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?

Score 1 point for a positive "yes". Score:____

____Yes

____ No

   K(C) Cut Down: Do you sometimes feel the need to cut down on your drinking?

Score 1 point for a positive "yes". Score:____

____Yes

____ No

  Total Score = _____

A total score of 2 or more points indicates a likely drinking problem.

 

Source: Russel, Marcia, Martier, Susan S., Sokol, Rober J., Mudar, Pamela, Bottoms, Sidney, Jacobsen, Sandra & Jacobsen, Joseph (1994). Screening for Pregnancy Risk-Drinking. Alcoholism: Clinical and Experimental Research, 18 (5): 1156-1161.

Brief Screening Test:  T-ACE

<Read It On Charlotte Kasl's Women At Risk Website>
Charlotte Kasl, Many Roads, One Journey: Moving Beyond the 12 Steps. 
Charlotte Kasl, P.0. Box 1302, Lolo MT 59847

T-ACE is a measurement tool of four questions that are significant identifiers of risk drinking (i.e., alcohol intake sufficient to potentially damage the embryo/fetus).

The T-ACE is completed at intake. The T-ACE score has a range of 0-5. The value of each answer to the four questions is totalled to determine the final T-ACE score.

Note:

1 Drink
= 12 oz beer
= 12 oz cooler
= 5 oz wine
= 1 mixed drink (1.5 oz. hard liquor)

Binge (drinking) = consuming 5 or more alcoholic drinks on an occasion

A total score of 2 or greater indicates potential risk for the purposes of Pregnancy Outreach Program identification of prenatal risk.

1. How many drinks does it take to make you feel high?
  1. less than or equal to 2 drinks
  2. more than 2 drinks
 

Tolerance

2. Have people annoyed you by criticizing your drinking?
  1. No
  2. Yes
 

Annoyance

3. Have you felt you ought to cut down on your drinking?
  1. No
  2. Yes
 

Cut Down

4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
  1. No
  2. Yes
 

Eye Opener

Total Score = _____  

Source:  Sokol, Robert J., "Finding the Risk Drinker in Your Clinical Practice" in G. Robinson and R. Armstrong (eds), Alcohol and Child/Family Health: Proceedings of a Conference with Particular Reference to the Prevention of Alcohol-Related Birth Defects. Vancouver, BC., December, 1988.

Alcohol & Drug Assessment Questionnaire

<Read It On Charlotte Kasl's Women At Risk Website>
Charlotte Kasl, Many Roads, One Journey: Moving Beyond the 12 Steps. 
Charlotte Kasl, P.0. Box 1302, Lolo MT 59847

Caffeine

How much of each of the following substances do you consume in a day? (greater than 400 mg/day = potential prenatal risk)

Substance Pre-pregnancy At intake
Coffee:
- Perc
- Drip
- Instant
Daily consumption in cups
___ cups x 110 mgs = _____ mgs
___ cups x 145 mgs = _____ mgs
___ cups x  75 mgs  = _____ mgs
Daily consumption in cups
___ cups x 110 mgs = _____ mgs
___ cups x 145 mgs = _____ mgs
___ cups x  75 mgs  = _____ mgs
Tea
- Regular
- Herbal
Daily consumption in cups
___ cups x  65 mgs  = _____ mgs
___ cups x   0  mgs = __0__ mgs
Daily consumption in cups
___ cups x  65 mgs  = _____ mgs
___ cups x   0  mgs = __0__ mgs
Cola ___ cans x  35 mgs  = _____ mgs ___ cans x  35 mgs  = _____ mgs

Smoking

When was the last time you smoked cigarettes, if ever?
___ Never smoked
___ Within the last 2 weeks
___ Within the last month
___ Within the last 3 months
___ Within the last 6 months
___ Within the last year
___ Over 1 year ago
Before you were pregnant, how many cigarettes, on average, did you smoke in a week?  _____
How many cigarettes, on average, did you smoke last week? (at prenatal intake)  _____

Alcohol

When was the last time you drank alcohol, if ever?
___ Never drank alcohol
___ Within the last 2 weeks
___ Within the last month
___ Within the last 3 months
___ Within the last 6 months
___ Within the last year
___ Over 1 year ago
Before you were pregnant, how many times (occasions) did you drink alcohol each week?  ____;  each month? ____
On average, how many drinks did you have on an occasion?  _____
Is there any history of misuse of alcohol by any of the following family members?
___ Biological mother
___ Biological father
___ Spouse/partner
___ Brother/sister
___ None apply
Have you had any treatment for alcohol use?
___ Yes:  Where? _________________________________________
              When? ________________
___ No
What is your understanding of the possible effects that drinking alcohol may have during pregnancy? (Fetal Alcohol Syndrome)?

Drugs

When was the last time you used drugs, if ever?
___ Never used drugs
___ Within the last 2 weeks
___ Within the last month
___ Within the last 3 months
___ Within the last 6 months
___ Within the last year
___ Over 1 year ago
Before you were pregnant, how many times (occasions), on average, did you use drugs each week? ____; each month? ____
In the past week, how many times did you use drugs? ____ (at intake)
Have you had any treatment for drug use?
___ Yes:  Where? _________________________________________
              When? ___________________________
___ No

Drugs Used (check all that apply)

Drug Within 2 weeks Within 1 month Within 6 months Within 1 year Over 1 year ago
Marijuana/THC          
Crack/Cocaine          
Cocaine (IV)          
LSD/Acid          
Heroin (IV)          
Heroin (other)          
Tylenol/Codeine
(T 3's)
         
Barbiturates and other tranquillizers          
Other tranquillizers          
Inhalants          
Other (specify):
________________
________________
       
 

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