Women At Risk - Brief Addiction Screening Tools

Women At Risk
Brief Addiction Screening

TWEAK T-ACE Alcohol & Drug Assessment Questionnaire

GORSKI-CENAPS Web Publications

Training & Consultation --- Books, Audio, & Video Tapes
www.tgorski.com ----- www.cenaps.com ----- www.relapse.org
Gorski-CENAPS, 17900 Dixie Hwy, Homewood, IL 60430, 708-799-5000

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? less than or equal to 2 drinks more than 2 drinks	Tolerance
2. Have people annoyed you by criticizing your drinking? No Yes	Annoyance
3. Have you felt you ought to cut down on your drinking? No 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? No 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): ________________ ________________

GORSKI-CENAPS Books - www.relapse.org
1-800-767-8181

Addiction - A Biopsychosocial Model

Denial Management Counseling (DMC)

Relapse Prevention Counseling (RPC)

Relapse Prevention Therapy (RPT)

Addiction-Free Pain Management (APM)

Food Addiction

Training & Consultation: www.tgorski.com, www.cenaps.com, www.relapse.org Gorski-CENAPS, 17900 Dixie Hwy, Homewood, IL 60430, 708-799-5000

Meet The GORSKI-CENAPS TEAM
Tresa Watson ----- Steve Grinstead ----- Arthur Trundy