Alcohol Screening Instruments for Women: Child Welfare Setting

1. Alcohol Screening Instruments for Women:Child Welfare Setting Center for Development of Human Services Wendy A. Lutz, MSW, CASAC Brenda A. Miller, Ph.D. Fall 2001

2. Rationale • “Over the past ten years, fueled by alcohol and illegal drugs, the number of abused and neglected children has more than doubled.” • “Substance abuse causes or exacerbates 7 out of 10 cases of child abuse and neglect.” • “89% of child welfare professionals named alcohol… as the number one drug abused by parents who abuse and neglect their children.”

3. Rationale • “Children whose parents abuse drugs and alcohol are almost three times likelier to be abused and more than four times more likely to be neglected than children of parents who are not substance abusers.” • “Children exposed prenatally to illicit drugs are 2 to 3 times likelier to be abused or neglected.” • Source: No Safe Haven: Children of Substance-abusing parents (1999) Reid, J; Macchetto, P.; Foster, S.

4. Language of Measurement • Screening – An instrument used to determine the need for further assessment. • Diagnostic – A tool that produces a diagnosis of substance abuse or substance dependence usually involving a lengthy interview and/or diagnostic tool.

5. Language of Measurement • Reliability – the instrument measures the concept consistently and dependably. • Validity – the instrument displays “goodness of fit” between the operational definition and the concept it is meant to measure.

6. Language of Measurement • Sensitivity – The probability that an individual who is a risk drinker will test positive using the screening tool. • Specificity -- The probability that an individual who is not a risk drinker will test negative using the screening tool.

7. Selection Criteria In consideration of the many constraints of the child welfare worker in the field, instruments were considered based on those constraints and the needs of the clients being served. The specific criteria follow.

8. Selection Criteria • The tool must screen for potential problems not diagnose problems. • The Social Services professional needs to screen for “risky drinking” in order to make a referral for further assessment. • The tool should require little or no training for administration.

9. Selection Criteria • The tool should have proven reliability and validity in a variety of settings. • The tool should be relatively brief allowing for oral administration in an interview setting.

10. Selection Criteria • The tool should be easily scored. • It is preferable that the tool be reliable, valid, sensitive and specific to women.

11. Reviewed Instruments Given these criteria the following instruments were reviewed: • Michigan Alcohol Screening Test (MAST) • CAGE (Cut-down, Annoyed, Guilty, Eye-opener) • Brief Michigan Alcohol Screening Test (BMAST)

12. Reviewed Instruments • T-ACE (Tolerance, Annoyed, Cut-down, Eye-opener) • T-WEAK (Tolerance, Withdrawal, Eye-opener, Annoyed, C(K)ut-down) • Alcohol Use Disorders Identification Test (AUDIT)

13. The Ones That Got Away… • MAST – too lengthy (22 questions), complicated scoring, no proven specificity/sensitivity with women. • BMAST – inferior specificity/sensitivity with women. • CAGE -- inferior specificity/sensitivity with women. • Additionally, all of the above included only obvious indicators that could trigger denial.

14. Recommended Tools AUDIT • Developed specifically under multi-cultural circumstances. • Designed to screen for alcohol problems at earlier stages. • Comprised of both direct or indirect indicators.

15. Recommended Tools TWEAK • Combines questions from the MAST and CAGE. • Developed in a study of obstetrics patients – specific to women. • Easily scored. • Based on a lifetime timeframe rather than just current use.

16. Recommended Tools T-ACE • Developed specifically for women. • Guilt question in CAGE replaced with tolerance. Guilt question has very low reliability with women • Easily scored. • Based on a lifetime timeframe rather than just current use.

17. Other Advantages • All instruments can be orally administered (although brevity of T-ACE and TWEAK make them more conducive to oral administration.) • Little or no training is required for proper administration.

18. Other Considerations • The relationship between the interviewer and client will effect outcome. • These are all self-report screens and are therefore only as accurate as the self-report. • A positive screen only indicates a need for further assessment; it is not necessarily an indication of a problem.

19. Other Considerations • These tools are specific to alcohol and do not specifically screen for other drug abuse. • The TWEAK and T-ACE are not designed to detect earlier stages of alcohol problems. • Further study is required to determine the multi-cultural reliability of these studies.

20. A Final Note Although these instruments require little training to administer, it is highly recommended that child welfare professionals become as familiar as possible with alcohol and other drug issues as they pertain to child welfare. The more the worker understands the issues the more useful these tools will be to them.

21. Thanks for listening! Any questions should be directed to: Wendy A. Lutz School of Social Work lutz@buffalo.edu