How to Coach Yourself and Others Empowering Coaching And Crisis Interventions | Page 171
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T-ACE
The T-ACE is a 4-item instrument appropriate for detecting heavy alcohol use in pregnant women (Sokol et al.
1989). T-ACE uses the A, C, and E questions from CAGE and adds one on tolerance for alcohol. The first
question assesses tolerance by asking if it takes more than it used to to get high. A response of two or more
drinks is scored as 2 points, and the remaining questions are assigned 1 point for a “yes” response. Scores range
from 0 to 5 points. A total of 2 or more points indicates risk drinking (Chang et al. 1999). T-ACE has sensitivity
equal to the longer MAST and greater than CAGE (Bradley et al. 1998c). It has been validated only for
screening pregnant women with risky drinking (Russell et al. 1994).
In a study with a culturally diverse population of pregnant women, Chang and colleagues (1998) compared TACE with the MAST (short version) and the AUDIT. The study found T-ACE to be the most sensitive of the
three tools in identifying current alcohol consumption, risky drinking, or lifetime alcohol diagnoses (Chang et
al. 1998). Although T-ACE had the lowest specificity of the three tests, it is argued that false positives are of
less concern than false negatives among pregnant women..
Prenatal substance abuse screen (5Ps)
This screening approach has been used to identify women who are at risk for substance abuse in prenatal health
settings. A “yes” response to any item indicates that the woman should be referred for assessment (Morse et al.
1997). Originally, four questions regarding present and past use, partner with problem, and parent history of
alcohol or drug problems were used (Ewing 1990). However, several adaptations have been made, and recently
a question about tobacco use in the month before the client knew she was pregnant was added (Chasnoff
2001). Chasnoff and colleagues (2001) reported that women who smoked in the month before pregnancy were
11 times more likely to be currently using drugs and 9 times more likely to be currently using either drugs or
alcohol or both while pregnant.
In a study evaluating prevalence of substance use among pregnant women utilizing this screening tool, the
authors suggest that it not only identified pregnant women with high levels of alcohol and drug use but also a
larger group of women whose pregnancies were at risk from smaller amounts of substance use (Chasnoff et al.
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