Alcohol Screening Instruments for Women: Child Welfare Setting

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Selection Criteria

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

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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)

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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)

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Thanks for listening!
Any questions should be directed to Wendy A.
Lutz School of Social Work lutz_at_buffalo.edu