How to Coach Yourself and Others Empowering Coaching And Crisis Interventions | Page 185

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psychological complications and decreasing the potential risk for relapse to manage weight. Eating disorder
screenings are not designed to establish an eating disorder diagnosis but instead to identify the need for
additional psychological and medical assessments by a trained mental health clinician and medical personnel.
The EAT-26 (Garner et al. 1982), or Eating Attitudes Test, is a widely used screening tool that can help identify
behaviors and symptoms associated with eating disorder risk (Garner et al. 1998). It is recommended that a twostage process be employed using the EAT-26: screening followed by a clinical interview. Specifically, if the
woman scores at or above a cutoff score of 20 on the EAT-26, she should be referred for a diagnostic interview.
For a copy of the screening tool and scoring instructions, refer to Appendix C.
Figure 4-8 lists questions that probe for an eating disorder. A woman with an eating disorder often feels shame
about her behavior, so the general questions help ease into the topic as the counselor explores the client’s
attitude toward her shape, weight, and dieting.

Screening by Healthcare Providers in Other Settings
Healthcare providers such as nurse practitioners, physicians, physicians’ assistants, and social service
professionals have opportunities to screen women to determine whether they use or abuse alcohol, drugs, or
tobacco. The most frequent points of entry from other systems of care are obstetric and primary care; hospital
emergency rooms; probation officer visits; and social service agencies in connection with housing, child care,
and domestic violence.
Our own preconceived images of women who are addicted, coupled with a myth that women are less likely to
become addicted, can undermine clinical judgment to conduct routine screenings for substance use.
Between 5 and 40 percent of people seeing physicians and/or reporting to hospital emergency rooms for care
have an alcohol use disorder (Chang 1997), but physicians often do not identify, refer, or intervene with these
patients (Kuehn 2008). Even clinicians who often use the CAGE or other screening tools for certain patients are
less likely to ask women these questions because women—particularly older women, women of Asian descent,
and those from middle and upper socioeconomic levels—are not expected to abuse substances (Chang
1997). Volk and colleagues (1996) found that, among primary care patients who were identified as “at risk” for
alcohol abuse or dependence by a screening questionnaire, men were 1.5 times as likely as women to be warned
about alcohol use and three times as likely to be advised to stop or modify their consumption. Women may be
less likely to have problems with alcohol or drugs than men (Kessler et al. 1994, 1995); however, when women
have substance use disorders, they experience greater health and social consequences.

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