Transcript Alcohol Screening Instruments for Women: Child Welfare Setting

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
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.”
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.
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.
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.
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.
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.
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.
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.
Selection Criteria
The tool should be easily scored.
It is preferable that the tool be reliable,
valid, sensitive and specific to women.
Reviewed Instruments
Given these criteria the following
instruments were reviewed:
Michigan Alcohol Screening Test (MAST)
CAGE (Cut-down, Annoyed, Guilty, Eyeopener)
Brief Michigan Alcohol Screening Test
(BMAST)
Reviewed Instruments
T-ACE (Tolerance, Annoyed, Cut-down,
Eye-opener)
T-WEAK (Tolerance, Withdrawal, Eyeopener, Annoyed, C(K)ut-down)
Alcohol Use Disorders Identification Test
(AUDIT)
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.
Recommended Tools
AUDIT
Developed specifically under multicultural circumstances.
Designed to screen for alcohol problems
at earlier stages.
Comprised of both direct or indirect
indicators.
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.
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.
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.
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 selfreport.
A positive screen only indicates a need
for further assessment; it is not
necessarily an indication of a problem.
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.
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.
Thanks for listening!
Any questions should be directed to:
Wendy A. Lutz
School of Social Work
[email protected]