Abstinence means not drinking any alcoholic beverage,including beer, wine, and hard
liquor. It is recommended that all pregnant women abstain from alcohol to avoid
Abstract thinking, or abstracting, often thought to develop around the age of 11
in children, includes a sense of space (microscopic space and cosmic space) and
time (historical time and future time). Many individuals with a variety of disabilities
have difficulty with abstract thinking. These difficulties appear to be common in
those with an FASD.
Addiction is a state of dependence caused by habitual use of drugs, alcohol, or
other substances. It is characterized by uncontrolled craving, tolerance, and symptoms
of withdrawal when access is denied. Habitual use produces changes in body chemistry,
and treatment must be geared to a gradual reduction in dosage.
Alcohol is a drink containing the substance ethanol.
Alcohol dependence is a DSM-IV diagnosis of a maladaptive pattern of substance use
as shown by three of the following criteria, noted in a 12-month period:
Pregnant women who are alcohol dependent are at risk of delivering a child with
Alcohol screening is a question-based method for identifying individuals with alcohol
problems and assessing the severity of use. Alcohol screening is extremely important
for pregnant women to ensure that they receive appropriate interventions to help
them deliver healthy infants. Alcohol screening is also important for all women
of childbearing age.
Alcoholism is a chronic, progressive, and potentially fatal disorder caused by both
genetic and environmental factors. It is characterized by tolerance and physical
dependence, manifested by the inability to control drinking behavior. It is often
accompanied by diverse personality changes and social consequences.
Alcohol-related birth defects (ARBD)
ARBD, a term coined by the Institute of Medicine in 1996, is used to describe individuals
with confirmed maternal alcohol use and one or more congenital defects, including
heart, bone, kidney, vision, or hearing abnormalities.
Alcohol-related neurodevelopmental disorder (ARND)
ARND, a term coined by the Institute of Medicine in 1996, is used to describe individuals
with confirmed maternal alcohol use, neurodevelopmental abnormalities, and a complex
pattern of behavioral or cognitive abnormalities inconsistent with developmental
level and not explained by genetic background or environment. Problems may include
learning disabilities, school performance deficits, inadequate impulse control,
social perceptual problems, language dysfunction, abstraction difficulties, mathematics
deficiencies, and judgment, memory, and attention problems.
Americans with Disabilities Act (ADA)
The ADA is a Federal law that prohibits discrimination on the basis of disability
in employment, State and local government, public accommodations, commercial facilities,
transportation, and telecommunications. An individual with a disability is defined
by the ADA as a person who has a physical or mental impairment that substantially
limits one or more major life activities, a person who has a history or record of
such an impairment, or a person who is perceived by others as having such an impairment.
The ADA does not specifically name all of the impairments that are covered.
The Alcohol Use Disorders Identification Test (AUDIT) is a simple ten-question test
developed by the World Health Organization to determine if a person's alcohol consumption
is excessive. WHO designed the test for international use and it was validated in
a six-country study. Questions 1-3 deal with alcohol consumption, 4-6 relate to
alcohol dependence and 7-10 consider alcohol related problems. A score of 8 or more
in men (7 in women) indicates a strong likelihood of hazardous or harmful alcohol
consumption. A score of 13 or more is suggestive of alcohol related harm.
- Withdrawal or use of alcohol to avoid withdrawal
- Use in larger amounts or for longer than intended
- Unsuccessful efforts to decrease or discontinue use or a persistent desire to do
- Alcohol use as a major focus of time and life
- Abandonment of social, occupational, or recreational activities
- Continued use despite recognized psychological or physical consequences.
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A behavior problem involves unusual or age-inappropriate behavior that affects the
child’s social and academic functioning (e.g., unusually high or low activity,
impulsivity, distractibility, aggression, poor frustration tolerance, self-regulation
difficulties, social and emotional problems).
Binge drinking generally refers to the consumption of four or more drinks in about
2 hours. Binge drinking during pregnancy can result in FASD.
Bipolar disorder, formerly known as manic-depressive illness, is a brain disorder
that causes unusual shifts in a person’s mood, energy, and ability to function.
Bipolar disorder can cause dramatic mood swings—from overly “high”
or irritable to sad and hopeless, and then back again, often with periods of normal
mood in between. It can also occur in individuals who do not have those dramatic
mood swings, but rather may have some highs or lows with some alternate periods
of leveling off. Severe changes in energy and behavior go along with these mood
changes. The periods of highs and lows are called episodes of mania and depression.
In adolescents, mania may be demonstrated by antisocial behavior rather than the
euphoria often seen in adults.
A birth defect is a physical or biochemical defect (e.g., Down syndrome, FAS, cleft
palate) that is present at birth and may be inherited or environmentally induced.
A brief intervention is approximately one to four therapy sessions delivered to
individuals with problem drinking and other problematic behaviors. The intervention
may include advice to abstain from alcohol use or decrease alcohol consumption to
below risk drinking levels, brief counseling, goal setting, and development of action
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The CAGE is a screening tool for identifying risk drinkers. The acronym stands for:
Each positive answer is scored as 1 point. A score of 2 or more points is considered
evidence of possible risk drinking. The CAGE has been used effectively to identify
alcoholic clients, but it may not be as sensitive as other brief scales with female
Central nervous system (CNS) impairments
The CNS consists of the brain and spinal cord and coordinates the activity of the
entire nervous system. CNS impairments include lack of coordination, cognitive deficits,
and impaired judgment.
CNS structural abnormalities involve damage to the brain itself as determined through
physical examination/manifestations or a brain scanning technique. They include
small head size (microcephaly), seizures, or small or missing brain structures.
Individuals with an FASD often have structural brain abnormalities, particularly
microcephaly, fewer basal ganglia (associated with motor activity), and small or
absent corpus callosum (which carry bundles of nerve fibers that connect the right
and left brain hemispheres). CNS functional abnormalities are abnormal or age-inappropriate
behaviors that are assumed to be related to structural brain damage (e.g., newborn
jitteriness, hyperactivity, attention problems, memory impairments).
In the field of substance abuse treatment, cognitive-behavioral therapy is an approach
that includes self-management and relapse prevention strategies. It is designed
to help individuals stop or reduce alcohol consumption by observing their drinking
behavior, setting behavioral objectives, or training in skills to handle conflicts
or stress without resorting to drinking.
The essential feature of conduct disorder is a repetitive and persistent pattern
of behavior in which the basic rights of others or major age-appropriate norms or
rules are violated. These behaviors may involve aggressive conduct that causes or
threatens physical harm to other people or animals, the deliberate destruction of
property, deceitfulness or theft, and serious violations of rules. Some individuals
with an FASD may be diagnosed with conduct disorder. This could be a co-occurring
disorder for some. Others may demonstrate what looks like conduct disorder but may
actually be a result of having difficulty understanding rules and requests. They
may be misdiagnosed with conduct disorder.
Congenital defects are imperfections with which a person is born, acquired during
development in the uterus. The defects may be due to genetics or to fetal injury
or insult (e.g., maternal alcohol use or infection). Infants with an FASD may be
born with congenital defects (e.g., heart defects, limb and joint abnormalities).
Contraception is any means of preventing pregnancy. It is advocated for use by women
who cannot or do not choose to stop consuming alcohol during childbearing years
in order to prevent an FASD.
Co-occurring refers to the simultaneous existence of a disorder (e.g., FAS) interacting
with one or more independent disorders (e.g., schizophrenia) or disabilities. The
disorder/disability is of a type and severity that exacerbates the other conditions,
complicates treatment, or interferes with functioning in age-appropriate social
roles. In substance abuse, it is typically used to describe persons who have both
mental illness and a substance abuse/dependence disorder.
- C—Have you ever felt you ought to Cut Down
on your drinking?
- A—Have people ever Annoyed you by criticizing
- G—Have you ever felt bad or Guilty about
- E—Have you ever had a drink first thing in the morning to
steady your nerves or get rid of a hangover (Eye-Opener)?
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Major depressive disorder is marked by a depressed mood or a loss of interest or
pleasure in daily activities consistently for at least 2 weeks. This mood must represent
a change from the person’s normal mood; social, occupational, educational,
or other important functioning must also be negatively impaired by the change in
mood. In children and adolescents, this mood may be demonstrated by irritability.
Developmental disabilities are a diverse group of physical, cognitive, psychological,
sensory, and speech impairments that begin any time during development up to 18
years of age.
Diagnosis is the process of determining disease status through the study of symptom
patterns and the factors responsible for producing them.
Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code
The 4-Digit Diagnostic Code was developed by the FAS Diagnostic and Prevention Network
at the University of Washington in response to the need to standardize criteria
for the diagnosis of fetal alcohol spectrum disorders. The four digits of the diagnostic
system consider the extent to which the individual presents with the four key diagnostic
features of FAS or related disorders: growth retardation, facial features, brain
dysfunction, and prenatal alcohol exposure. An individual receives a rank on each
of these scales and a diagnostic code based on the pattern of the four rankings.
Twelve different 4-digit diagnostic code patterns may indicate an FAS diagnosis.
Various other patterns may indicate atypical FAS, static encephalopathy, neurobehavioral
disorder, or no detected cognitive or physical findings. The 4-Digit Diagnostic
Code has shown excellent consistency and reliability.
Dysmorphology is a term coined by the late Dr. David W. Smith for the study of human
congenital malformations. A dysmorphologist is a clinician that specializes in this
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Ethnicity, ethnic background
Ethnicity refers to racial, national, tribal, religious, linguistic, or cultural
origin or background. Rates of FASD vary among ethnic groups. For example, some
Native American populations have higher rates of FASD than the general population.
Executive functioning deficits
Executive function deficits, which are often attributed to dysfunction in the frontal
lobe of the brain, primarily involve difficulty forming, planning, and carrying
out goal-directed activities. Executive functions also include the ability to change
behaviors in different situations.
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FAS facial anomalies or abnormalities are a pattern of abnormal facial features
including short palpebral fissures, thin upper lip, and flattened philtrum.
Failure to thrive
Failure to thrive is a term used to describe children early in life who do not receive
or are unable to take in or retain adequate nutrition to gain weight and grow as
expected. Often, children with FAS are initially diagnosed with failure to thrive.
FAS facial phenotype
The FAS facial phenotype is one of the diagnostic criteria in the 4-Digit Diagnostic
Code developed by the FAS Diagnostic and Prevention Network at the University of
Washington. Three features (palpebral fissure length, philtrum smoothness, and upper
lip thinness) are measured to document the magnitude of expression of the FAS facial
FASD screening is a technique that uses a variety of tools to identify individuals
who show signs of an FASD in infancy and early childhood or who are known to have
had prenatal alcohol exposure. It can also be used to identify adolescents and adults
who may have the disorder and have not been previously diagnosed.
Fetal alcohol spectrum disorders (FASD)
FASD is an umbrella term describing the range of effects that can occur in an individual
whose mother drank alcohol during pregnancy. These effects may include physical,
mental, behavioral, and/or learning disabilities with possible lifelong implications.
The term FASD is not intended for use as a clinical diagnosis.
Fetal alcohol syndrome (FAS)
FAS is the term coined in the United States in 1973 by Dr. Kenneth Jones and Dr.
David Smith at the University of Washington to describe individuals with documented
prenatal exposure to alcohol and (1) prenatal and postnatal growth retardation,
(2) characteristic facial features, and (3) central nervous system problems.
A fetus is a developing being, usually from 3 months after conception until birth
for humans. Prior to that time, the developing being is typically referred to as
Free and appropriate public education (FAPE)
Children with disabilities are entitled to a FAPE in the least restrictive environment
appropriate to their individual needs, according to the Individuals with Disabilities
Education Act (IDEA).
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Genetic disorders are caused by a disturbance of one gene or several genes or chromosomes.
They may be inherited or caused by environmental factors. Genetic disorders may
cause various diseases and disorders, such as hemophilia and mental retardation
(e.g., Down syndrome).
Gestational age is the time measured from the first day of the woman's last menstrual
cycle to the current date. It is measured in weeks.
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Health Insurance Portability and Accountability Act (HIPAA)
Established in 1996, HIPAA requires the Department of Health and Human Services
to establish national standards for electronic health care transactions and national
identifiers for providers, health plans, and employers. It also addresses the security
and privacy of health data.
Heavy drinking generally refers to the consumption of five or more drinks on the
same occasion on 5 or more days in the past month. Heavy drinking during pregnancy
can result in an FASD.
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An impulse is a sudden spontaneous inclination or incitement to some usually unpremeditated
action. It is a force that often produces sudden motion, which sometimes is inhibited.
For example, an individual might swing at another person who bumps into him or her
by accident, or a child may have an impulse to run away and may run away or resist
the impulse and not run away.
Indicated prevention efforts target high-risk individuals who have signs or symptoms
of a condition or have biologic markers indicating predisposition. Targets of indicated
prevention include women who abuse alcohol, such as women who binge drink while
pregnant, particularly pregnant or preconceptional women who drink alcohol and have
already given birth to children with an FASD. Substance abuse treatment for pregnant
women is a form of indicated prevention.
An IEP is a blueprint for a child’s special education needs and related services.
All public school children who receive special education must have an IEP. By law,
certain individuals must be involved in writing a child’s IEP, including teachers,
parents, school administrators, related services personnel, and students (when appropriate).
Individuals with Disabilities Education Act (IDEA)
IDEA (formerly the Education for all Handicapped Children Act of 1975) requires
public schools to make available to all eligible children with disabilities a free
and appropriate public education in the least restrictive environment appropriate
to their individual needs. The Act was amended most recently in 2004.
Institute of Medicine (IOM) Diagnostic Criteria for FAS and Alcohol-Related Effects
The 1996 IOM diagnostic criteria for FAS were developed to refine definitions and
enhance the consistency of the terminology used to describe varying effects of prenatal
alcohol exposure. The criteria use a gestalt procedure in which experienced clinicians
determine the degree to which the individual meets the specified criteria for FAS
(with or without confirmed maternal alcohol exposure), partial FAS, ARBD, and ARND.
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Learning disabilities (LD) are identified difficulties with reading, writing, spelling,
computing, or communication. LD affects people’s ability to either interpret
what they see and hear or to link information from different parts of the brain.
These limitations can show up in many ways, as specific difficulties with spoken
and written language, coordination, self-control, or attention. Such difficulties
extend to schoolwork and can impede learning to read, write, or do math.
Low birth weight
According to current growth charts, low birth weight is a weight below 5 pounds
at the time of birth. This standard may need to be revised to reflect variations
among different racial and ethnic groups.
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Medicaid is a program that provides medical benefits to certain low-income individuals
and families. Although the Federal government establishes general guidelines for
the program, Medicaid eligibility and services are established by each State.
Mental retardation is a disorder characterized by a significantly below-average
score on a test of intellectual ability and limitations in such areas as self-direction,
school, work, leisure activities, daily living, and social and communication skills.
About 27 percent of individuals with FAS and 9 percent with fetal alcohol effects
meet intelligence quotient (IQ) criteria for mental retardation (70 or below).
Alcohol metabolism refers to the body’s process of converting ingested alcohol
to other compounds. Metabolism results in some substances becoming more or less
toxic than those originally ingested. Metabolism involves a number of processes,
one of which is oxidation. Through oxidation, alcohol is detoxified and removed
from the blood, preventing the alcohol from accumulating and destroying cells and
organs. A minute amount of alcohol escapes metabolism and is excreted unchanged
in the breath and in urine. Until all the alcohol consumed has been metabolized,
it is distributed throughout the body, affecting the brain and other tissues. Women
who have problems metabolizing alcohol may be more likely to deliver infants with
Microcephaly is a congenital anomaly of the CNS where the head circumference is
more than 3 standard deviations below the mean for age and sex.
Motivational interviewing (MI)
MI is a structured brief intervention procedure for people with substance use problems.
It includes clinician empathy and advice, feedback, establishment of client responsibility,
determination of options, and encouragement of the client’s self-efficacy
in changing behavior.
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Neurodevelopmental abnormalities are CNS abnormalities, such as small head size
at birth, and structural brain abnormalities leading to impaired fine motor skills,
hearing loss, gait problems, and poor eye-hand coordination.
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Oppositional defiant disorder (ODD)
The essential feature of ODD is a recurrent pattern of negative, defiant, disobedient,
and hostile behavior toward authority figures that persists for at least 6 months.
Physical aggression is not typically seen in those with ODD. Some individuals with
an FASD may be diagnosed with ODD, which could be co-occurring ODD. Others may seem
oppositional but may not understand the request made or be able to follow multiple
directions. They may be misdiagnosed with ODD.
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Palpebral fissures are eye openings. People with FAS have short palpebral fissures.
The palpebral fissure is measured from the inner canthus (corner) of the eye to
the outer canthus of the eye. Short palpebral fissures usually measure below
–2 standard deviations for age.
Partial FAS (pFAS)
Partial FAS is a term used to describe a cluster of problems in individuals who
are known to have faced significant prenatal exposure to alcohol and have some signs
of FAS. These include some of the characteristic facial abnormalities associated
with FAS and evidence of one other component of FAS: growth deficiency, neurodevelopmental
abnormalities, or behavioral or cognitive abnormalities unexplained by family background
The philtrum is the vertical groove between the nose and the middle part of the
upper lip. Individuals diagnosed with FAS have a flattening of the philtrum.
The placenta is the organ that allows nutrients and oxygen in the mother’s
blood to pass to the fetus and metabolic waste and carbon dioxide from the fetus
to cross in the other direction. The two blood supplies do not mix. When a mother
drinks during pregnancy, the alcohol crosses the placenta to the fetus.
Postnatal refers to events occurring after birth.
Prenatal refers to events existing or occurring before birth.
Prenatal care involves medical care and monitoring received during pregnancy. Prenatal
care is necessary for healthy pregnancies, particularly for women with alcohol or
drug issues, poor nutrition, or medical illnesses and women who take medication.
Prenatal exposure to alcohol (PEA), prenatal alcohol exposure
PEA refers to the exposure of a fetus to alcohol through maternal drinking during
The prevalence of a disorder is the number of instances of the disorder in a given
population at a designated time. The prevalence of FASD is estimated to be at least
10 per 1,000 live births.
Prevention is the protection of health through personal and communitywide efforts.
FASD is 100 percent preventable if women do not drink while pregnant.
An individual with problem drinking has issues concerning alcohol use and may require
treatment to manage the problem. Women of childbearing age who are problem drinkers
require intervention to increase the chances of abstinence during pregnancy and
the birth of a healthy child.
A psychometric test is any standardized procedure for measuring sensitivity, memory,
intelligence, aptitude, personality, etc.
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Reactive attachment disorder
The essential feature of reactive attachment disorder is markedly disturbed and
developmentally inappropriate social relatedness in most contexts that begins before
age 5 and is associated with grossly pathologic care. Children with reactive attachment
disorder may be excessively inhibited, hypervigilant, or highly ambivalent in response
to caregivers or may exhibit indiscriminate sociability or a lack of selectivity
in the choice of attachment figures. Children with an FASD who are adopted or in
foster care may be diagnosed with reactive attachment disorder; however, whether
the disturbed pattern of social relating is due to brain damage or environmental
causes remains unknown.
Residential treatment is a living setting designed for individuals who have difficulty
living with family or on their own due to physical problems, developmental disabilities,
or mental illness. It provides adult supervision, therapy, and skills training in
a large or small group setting. Residential treatment may be necessary for some
children, adolescents, and adults with an FASD, as they may be unable to live successfully
in the community without supervision.
Respite care is care for an individual by a person other than the usual caregiver
as a form of rest or relief for the caregiver. Respite care is an important service
for caregivers of individuals with an FASD due to their high needs.
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Schizophrenia is a brain disorder usually diagnosed during the teen or early adult
years. In rare cases, schizophrenia is diagnosed in children. The symptoms of schizophrenia
are usually divided into two categories: positive and negative. “Positive”
refers to overt symptoms that should not be there, such as delusions and hallucinations.
“Negative” refers to a lack of characteristics that should be there.
Negative symptoms include emotional flatness, inability to start and complete tasks,
brief speech that lacks content, and lack of pleasure or interest in life. Symptoms
of schizophrenia may overlap with other disorders, such as bipolar disorder. Persons
whose symptoms cannot be clearly categorized are sometimes diagnosed as having a
Secondary disabilities are specific problems that may arise after birth in individuals
with an FASD. They may be ameliorated through better understanding of the disorder,
early identification, and appropriate early interventions. Secondary disabilities
associated with FASD include disrupted school experiences, trouble with the law,
confinement in mental health/substance abuse treatment/criminal justice facilities,
inappropriate sexual behavior, substance abuse disorders, dependent living, and
problems with employment.
The sensitivity of a screening test is the proportion of truly disordered persons
in the screened population who correctly test positive.
Sensory integration (SI) dysfunction
SI dysfunction is a neurologic disorder involving the inefficient brain processing
of information received through the senses. People with SI dysfunction experience
problems with learning, development, and behavior.
Social perceptual problems
Problems in social perception involve the lack of awareness of the consequences
of behavior, conversational deficits (e.g., interrupting, poor timing), and the
inability to comprehend nonverbal communication (e.g., facial expressions and hand
Social Security Disability Insurance (SSDI)
Social Security Disability Insurance (SSDI) is a Federal program that provides monthly
payments to eligible workers and certain members of their families. To be eligible,
the worker must be “insured,” meaning that he or she worked long enough
and paid Social Security taxes. Disability benefits are payable to blind or disabled
workers, widow(er)s, or adults disabled since childhood, who are otherwise eligible.
The amount of the monthly disability benefit is based on the Social Security earnings
record of the insured worker.
Social skills problems
Social skills deficits involve difficulty in effectively interacting and communicating
with others, especially in developing and keeping friendships.
The specificity of a screening test is the proportion of those without disease who
correctly test negative.
Stages of change theory
A model of the stages of readiness for behavioral change, composed of precontemplation,
contemplation, preparation, action, maintenance, and relapse. Counselors can use
motivational interviewing to help clients make decisions for themselves along the
stages of change.
Because alcoholic beverages vary in alcohol concentration, drinks are designated
by a standard drink conversion. One standard drink is 12 ounces of beer, 5 ounces
of wine, or 1.5 ounce of hard liquor. All have the same equivalency of 0.48 ounces
of absolute alcohol.
Strategic Prevention Framework
SAMHSA’s Strategic Prevention Framework is a systemic community-based approach
that aims to ensure that substance abuse prevention programs produce results. The
framework uses the findings from public health research along with evidence-based
prevention programs to build capacity within States and the prevention field.
Substance abuse treatment
Substance abuse treatment is a therapeutic program, staffed by addiction professionals,
for individuals with alcohol or drug problems. It may involve inpatient or outpatient
Sudden infant death syndrome (SIDS)
SIDS is the sudden death of an infant less than 1 year of age that cannot be explained
by information collected during a thorough investigation.
Supplemental Security Income (SSI)
SSI is a Federal income supplement program funded by general tax revenues and administered
by Social Security. It is designed to help people with limited income who are disabled,
blind, or over 65 by providing monthly benefits to meet basic needs for food, clothing,
and shelter. Disabled children, as well as adults, can receive SSI benefits.
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T-ACE is a screening tool for identifying pregnant women with alcohol problems.
The acronym stands for:
The tolerance question is scored as 2 points if the respondent reports needing more
than two drinks to get high. A positive response to A, C, or E is scored as 1 point
each. A score of 2 or more indicates likely drinking during pregnancy. The T-ACE
has been found to be effective in identifying pregnant women who consumed sufficient
amounts of alcohol to endanger a fetus.
A teratogen is any substance, such as alcohol, or condition, such as measles, that
can cause damage to a fetus, resulting in deformed fetal structures. Alcohol causes
birth defects and brain damage, resulting in neurobehavioral problems in exposed
A trimester is a 3-month period during pregnancy. Pregnancy is divided into three
trimesters. Alcohol-related damage to a fetus can occur anytime during a pregnancy.
Specific problems can occur during each trimester. For example, alcohol exposure
during the first trimester can cause FAS facial features. Heavy drinking during
the second trimester increases the risk of miscarriage. Drinking during the third
trimester may lead to neurodevelopmental abnormalities and growth retardation. Effects
on brain development can occur in any trimester of pregnancy.
TWEAK is a screening tool for identifying pregnant women with alcohol problems.
The acronym stands for:
- T—Tolerance: How many drinks does it take you to feel high?
- A—Annoyed: Have people annoyed you by criticizing your drinking?
- C—Cut Down: Have you ever felt you ought to cut down on your
- E—Eye-opener: Have you ever had a drink first thing in the
morning to steady your nerves or get rid of a hangover?
On the tolerance question, 2 points are given if a woman reports that she can consume
more than 5 drinks without falling asleep or passing out. A positive response to
the worry question yields 2 points and positive responses to the last three questions
yield 1 point each. A score of 2 signals an at-risk drinker. TWEAK has been found
to be highly sensitive in identifying women who are at-risk drinkers.
- T—Tolerance: How many drinks can you hold?
- W—Have close friends or relatives Worried or complained
about your drinking in the past?
- E—Eye-Opener: Do you sometimes take a drink in the morning?
- A—Amnesia: Has a friend or family member ever told you about
things you said or did while you were drinking that you could not remember?
- K(c)—Do you sometimes feel the need to Cut Down on your drinking?
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Universal prevention strives to ensure that all members of society understand that
a behavior, such as drinking alcohol during pregnancy, can have hazardous consequences.
Mass media campaigns to the general public over radio and TV are examples of universal
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Vocational rehabilitation comprises services that help eligible individuals achieve
employment, such as vocational counseling and referral, job training, and job placement.
States receive Federal grants to operate a comprehensive vocational rehabilitation
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