Alcohol and Women: How to Screen and Intervene

Joe Sniezek, MD, MPH


January 22, 2013

Editorial Collaboration

Medscape &

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Hello. I am Dr. Joe Sniezek with CDC's Division of Birth Defects and Developmental Disabilities. I am pleased to speak to you as part of the CDC Expert Commentary Series on Medscape. Today I will discuss how to detect, and intervene with, women who drink alcohol at risky levels, based on guidance from the American College of Obstetricians and Gynecologists (ACOG).

At-risk alcohol use for healthy women is defined as more than 7 drinks per week or more than 3 drinks per occasion, and any amount of drinking for women who are pregnant or could become pregnant. Women are particularly vulnerable to the physical and psychosocial health risks associated with excessive alcohol use.

Alcohol-related mortality is the third leading cause of preventable death for women in the United States. At-risk alcohol use results in multiple adverse health effects, including an increased risk for breast cancer.

Alcohol is also a teratogen, which can cause miscarriage, stillbirth, and a range of lifelong physical and neurobehavioral defects known as "fetal alcohol spectrum disorders." Pregnant women should not drink any alcohol. Pregnant women who have already consumed alcohol should stop in order to minimize further risk, and those who are trying to conceive should abstain from drinking alcohol.

The US Preventive Services Task Force recommends that all adults in a primary care setting be screened for alcohol misuse and provided counseling for identified risky drinking. Because women are particularly vulnerable from at-risk alcohol use, obstetrician-gynecologists have important opportunities for identifying and intervening with women at risk. This can be done in 3 quick, effective, and reimbursable steps.

Step 1: Screening. The first step is identifying women who drink at risky levels: All women seeking obstetric-gynecologic care should be screened for alcohol use at least yearly and, for pregnant women, at least within the first trimester of pregnancy.

Screening can be accomplished using simple validated tools with additional questions about the quantity and frequency of alcohol use, within the context of a routine visit. Importantly, most women who use alcohol at risky levels have no signs on physical examination.

A detailed medical history obtained by a trusted clinician remains the most sensitive means of detecting risky alcohol use.

Step 2: Intervention. The second step is encouraging healthy behaviors through brief intervention and education. Many women might be surprised to learn that their drinking exceeds a safe level of alcohol consumption.

Offering compassionate education; exploring practical strategies to reduce use, such as socializing with people who will help her to not drink; and requesting a follow-up appointment are part of a successful strategy for many women who are not dependent on alcohol. Brief, motivation-enhancing interventions are associated with sustained reductions in alcohol consumption.

At the conclusion of the brief intervention, it is important to assist the patient to set a goal, record the goal, and let her know that there will be a follow-up discussion at the next visit.

Step 3: Referral. The third step is referring patients who are alcohol dependent for professional treatment. Women who continue to drink or use alcohol at risky levels and women who exhibit signs of alcohol dependence require referral to a substance abuse specialist.

If the patient refuses treatment, the provider should respect her decision, make a short-term follow-up appointment, and assure her that she will be welcomed back in the clinician's office.

Details on how to identify and intervene with women at risk for alcohol misuse are available from an ACOG Website dedicated to women and alcohol. This Website has screening instruments, sample scripts for conducting brief interventions, and information on billing codes for these clinical visits.

Web Resources

ACOG Women and Alcohol

ACOG Committee Opinion: At-Risk Drinking and Alcohol Dependence - Obstetric and Gynecologic Implications

ACOG Committee Opinion: Motivational Interviewing: A Tool for Behavior Change

CDC Fetal Alcohol Spectrum Disorders

CDC: Alcohol and Public Health

Substance Abuse and Mental Health Services Administration Treatment Services Locator

Joe Sniezek, MD, MPH, Chief of CDC's Prevention Research Branch in the National Center on Birth Defects and Developmental Disabilities, manages a branch whose activities include prevention of fetal alcohol syndrome, a global effort to prevent neural tube defects, a health communications campaign to increase awareness of developmental milestones, and prevention of congenital cytomegalovirus.

Previously, Dr. Sniezek has worked in several centers at CDC, including the National Center for Injury Prevention and Control, addressing injury surveillance and working with states to develop injury control and surveillance programs, especially related to traumatic brain and spinal cord injuries. Dr. Sniezek served as the Chief of the Arthritis Program in the National Center for Chronic Disease Prevention and Health Promotion from 1999 through 2007, where he managed a multidisciplinary team working to develop and implement public health approaches to improve the quality of life among persons affected by arthritis.

Dr. Sniezek received his BA from Culver-Stockton College and his medical and public health degrees from the University of Illinois at Chicago, where he also trained in preventive medicine.