4-Digit Diagnostic Code was developed by the Fetal Alcohol Syndrome
(FAS) Diagnostic and Prevention Network at the University of Washington
in response to the need to standardise criteria for the diagnosis of
fetal alcohol spectrum disorders. The four digits of the diagnostic
system consider the extent to which the individual presents with the
four key diagnostic features of FAS or related disorders: growth
retardation, facial features, brain dysfunction and prenatal alcohol
exposure. An individual receives a rank on each of these scales and a
diagnostic code based on the pattern of the four rankings. Twelve
different 4-digit diagnostic code patterns may indicate an FAS
diagnosis. Various other patterns may indicate atypical FAS, static
encephalopathy, neurobehavioural disorder or no detected cognitive or
physical findings. The 4-Digit Diagnostic Code has shown excellent
consistency and reliability.
means not drinking any alcoholic beverage, including beer, wine and
spirits. It is recommended that all pregnant women abstain from
alcohol to avoid fetal damage.
thinking, often thought to develop around the age of 11 in normal
children, includes a sense of space (microscopic space and cosmic
space) and time (historical time and future time). Many individuals
with a variety of disabilities have difficulty with abstract thinking.
These difficulties appear to be common in those with an FASD.
Adaptive Behaviour Composite Score
Adaptive Behaviour Composite Score is a measure of the person's ability
to express and comprehend language, behave appropriately in
interpersonal situations, understand and use social behaviours, protect
him/herself and care for him/herself, in terms of personal hygiene and
domestic independence. It is measured with instruments such as the
Vineland Adaptive Behaviour Scales, which measure adaptive behaviour in
four major domains, Communication, Daily Living Skills, socialisation
and Gross Motor Skills.
functioning refers to the ability to adjust to a situation or an
environment (e.g., sitting quietly in a classroom, taking the bus) and
to complete the tasks necessary in various life domains such as daily
living, socialisation and communication. Individuals with an FASD
often have deficits in adaptive functioning.
is a state of dependence caused by habitual use of drugs, alcohol or
other substances. It is characterized by uncontrolled craving,
tolerance and symptoms of withdrawal when access is denied. Habitual
use produces changes in body chemistry and treatment must be geared to
a gradual reduction in dosage.
Services that help with the transition from a treatment facility to community living, such as housing and job support.
is the subjective aspect of an emotion considered apart from bodily
changes. The term is often used as a name for feeling, emotion or mood.
Alcohol is a drink containing the substance ethanol.
Alcohol abuse is a DSM-IV diagnosis of a maladaptive pattern of
substance use as shown by one or more of the following criteria, when
criteria for alcohol dependence for this class of substance have never
Recurrent alcohol use leading to failure to fulfil major role obligations at work, school or home
Recurrent substance use that puts the individual in physical danger
Legal problems related to use
Adverse social and interpersonal consequences
Pregnant women meeting the criteria for alcohol abuse may be at risk of delivering a child with an FASD.
Alcohol dependence is a DSM-IV diagnosis of a maladaptive pattern of
substance use as shown by three of the following criteria, noted in a
Withdrawal or use of alcohol to avoid withdrawal
Use in larger amounts or for longer than intended
Unsuccessful efforts to decrease or discontinue use or a persistent desire to do so
Alcohol use as a major focus of time and life
Abandonment of social, occupational or recreational activities
Continued use despite recognised psychological or physical consequences.
Pregnant women who are alcohol dependent are at risk of delivering a child with an FASD.
metabolism refers to the body’s process of converting ingested alcohol
to other compounds. Metabolism results in some substances becoming more
or less toxic than those originally ingested. Metabolism involves a
number of processes, one of which is oxidation. Through oxidation,
alcohol is detoxified and removed from the blood, preventing the
alcohol from accumulating and destroying cells and organs. A minute
amount of alcohol escapes metabolism and is excreted unchanged in the
breath and in urine. Until all the alcohol consumed has been
metabolized, it is distributed throughout the body, affecting the brain
and other tissues. Women who have problems metabolizing alcohol may be
more likely to deliver infants with an FASD.
Alcoholic Beverage Labeling Act
1988, the Alcoholic Beverages Labeling Act (USA) required that a federally
mandated warning label be placed on all alcoholic beverages. The
warning includes the following language: “According to the Surgeon
General, women should not drink alcoholic beverages during pregnancy
because of a risk of birth defects.”
is a chronic, progressive and potentially fatal disorder caused by
both genetic and environmental factors. It is characterized by
tolerance and physical dependence, manifested by the inability to
control drinking behaviour. It is often accompanied by diverse
personality changes and social consequences.
Alcohol-related birth defects (ARBD)
ARBD, a term coined by the Institute of Medicine in 1996, is used to
describe individuals with confirmed maternal alcohol use and one or more congenital defects, including heart, bone, kidney, vision or
ARND, a term coined by the Institute of Medicine (USA) in 1996, is used to
describe individuals with confirmed maternal alcohol use,
neurodevelopmental abnormalities and a complex pattern of behavioural
or cognitive abnormalities inconsistent with developmental level and
not explained by genetic background or environment. Problems may
include learning disabilities, school performance deficits, inadequate
impulse control, social perceptual problems, language dysfunction,
abstraction difficulties, mathematics deficiencies and judgment,
memory and attention problems.
Attention-deficit/hyperactivity disorder (ADHD)
essential features of ADHD are a persistent pattern of inattention or
hyperactivity/impulsivity that is more frequently displayed and more
severe than is typically observed in individuals at a comparable level
of development. Children and adolescents with an FASD often meet the
diagnostic criteria for ADHD. However, they may have co-occurring ADHD
or they may exhibit symptoms that look like ADHD but are due to other
difficulties, including FASD.
behaviour problem involves unusual or age-inappropriate behaviour that
affects the child’s social and academic functioning (e.g., unusually
high or low activity, impulsivity, distractibility, aggression, poor
frustration tolerance, self-regulation difficulties, social and
High probability of a behaviour being seen in persons with a particular condition
drinking generally refers to the consumption of 6 units of alcohol in
about 2 hours.
50 ml of rum, vodka or whiskey = 2 units approx.
175 ml / standard glass of wine = 2 units approx.
250 ml large glass of wine = 3 units approx.
1 pint of Beer or Lager (depending upon strength) = 3 units approx.
For further information go to
Binge drinking during pregnancy can result in FASD.
disorder, formerly known as manic-depressive illness, is a brain
disorder that causes unusual shifts in a person’s mood, energy and
ability to function. Bipolar disorder can cause dramatic mood
swings—from overly “high” or irritable to sad and hopeless and then
back again, often with periods of normal mood in between. It can also
occur in individuals who do not have those dramatic mood swings, but
rather may have some highs or lows with some alternate periods of
leveling off. Severe changes in energy and behaviour go along with these
mood changes. The periods of highs and lows are called episodes of
mania and depression. In adolescents, mania may be demonstrated by
antisocial behaviour rather than the euphoria often seen in adults.
birth defect is a physical or biochemical defect (e.g., Down syndrome,
FAS, cleft palate) that is present at birth and may be inherited or
Blood alcohol concentration (BAC)
is the amount of alcohol present in a person’s bloodstream at a given
time after alcohol use. There is no known safe level of alcohol for the
called nursing, breastfeeding is the provision of breast milk to an
infant directly from the breast. Some mothers choose to express breast
milk into a bottle. Regardless of the method of delivery, breast milk
can transmit alcohol to an infant if the mother drinks. This can affect
brain development, which continues after birth.
interventions are approximately one to four therapy sessions delivered
to individuals with problem drinking and other problematic behaviours.
The intervention may include advice to abstain from alcohol use or
decrease alcohol consumption to below risk drinking levels, brief
counselling, goal setting and development of action plans.
structural abnormalities involve damage to the brain itself as
determined through physical examination/manifestations or a brain
scanning technique. They include small head size (microcephaly),
seizures or small or missing brain structures.Individuals with an FASD
often have structural brain abnormalities, particularly microcephaly,
fewer basal ganglia (associated with motor activity) and small or
absent corpus callosum (which carry bundles of nerve fibres that
connect the right and left brain hemispheres).
the field of substance abuse treatment, cognitive-behavioural strategies
are a group of procedures that include self-management and relapse
prevention strategies. They are designed to help individuals stop or
reduce alcohol consumption by observing their drinking behaviour,
setting behavioural objectives or training in skills to handle
conflicts or stress without resorting to drinking.
is any means of preventing pregnancy. It is advocated for use by women
who cannot or do not choose to stop consuming alcohol while pregnant in
order to prevent FASD.
Co-occurring refers to the simultaneous existence of a disorder (e.g.,
FAS) interacting with one or more independent disorders (e.g.,
schizophrenia) or disabilities. The disorder/disability is of a type
and severity that exacerbates the other conditions, complicates
treatment or interferes with functioning in age-appropriate social
roles. In substance abuse, it is typically used to describe persons who
have both mental illness and a substance abuse/dependence disorder.
is the process of determining disease status through the study of
symptom patterns and the factors responsible for producing them.
Diagnostic and Statistical Manual of Mental Disorders (DSM)
by the American Psychiatric Association in 1994, the DSM-IV is the main
diagnostic reference of mental health professionals in the United
States. FASD is not yet a diagnostic category in the DSM.
Dysmorphology is a term coined by the late Dr. David W. Smith for the study of human congenital malformations.
refers to racial, national, tribal, religious, linguistic or cultural
origin or background. Rates of FASD vary among ethnic groups.
function is the process or processes that enable an individual to set
and reach goals by organising, strategising, sequencing and sustaining
behaviour to achieve those goals. It helps a person to connect and apply
past experience to present action.
to thrive is a term used to describe children early in life who do not
receive or are unable to take in or retain adequate nutrition to gain
weight and grow as expected. Often, children with FAS are initially
diagnosed with failure to thrive.
Fetal alcohol effects (FAE)
is a term used to describe individuals exposed prenatally to alcohol
who have some, but not all, of the features of FAS. These features may
include developmental delay, cognitive impairments and/or behavioural
abnormalities. These individuals often have similar patterns of
behaviour to those with FAS but lack the characteristic facial features
of FAS. FAE is a descriptive term and is not meant to be used as a
Fetal alcohol spectrum disorders (FASD)
is an umbrella term describing the range of effects that can occur in
an individual whose mother drank alcohol during pregnancy. These
effects may include physical, mental, behavioural and/or learning
disabilities with possible lifelong implications. The term FASD is not
intended for use as a clinical diagnosis.
Fetal alcohol syndrome (FAS)
is the term coined in the United States in 1973 by Dr. Kenneth Jones
and Dr. David Smith at the University of Washington to describe
individuals with documented prenatal exposure to alcohol and (1)
prenatal and postnatal growth retardation, (2) characteristic facial
features and (3) central nervous system problems.
Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis
guidelines were published in 2004 by the Centers for Disease Control
and Prevention (USA), in collaboration with the National Task Force on Fetal
Alcohol Syndrome and Fetal Alcohol Effect. They are intended to assist
physicians and allied health professionals in the timely
identification, referral and diagnosis of persons with FAS. The
guidelines include specific diagnostic criteria in the areas of facial
dysmorphia, growth problems, central nervous system abnormalities and
maternal alcohol exposure.
Fetal hypoxia refers to low levels of oxygen during fetal development,
which can cause brain damage. Prenatal alcohol exposure may cause fetal
fetus is a developing being, usually from 3 months after conception
until birth for humans. Prior to that time, the developing being is
typically referred to as an embryo.
Frontal lobe defects
frontal lobes of the brain are responsible for higher cognitive thought
processes. These include self-control, maturity, judgment, tactfulness
and reasoning. Persons with an FASD may have frontal lobe defects that
impair these abilities.
gender-specific substance abuse treatment programme has specific services
for one gender or is only open to a single gender (e.g., women’s
residential treatment). Women with substance abuse problems generally
do better in gender-specific programmes.
disorders are caused by a disturbance of one gene or several genes or
chromosomes. They may be inherited or caused by environmental factors.
Genetic disorders may cause various diseases and disorders, such as
haemophilia and mental retardation (e.g., Down syndrome).
British Government guidelines recommend that women should drink no more than 2-3 units a day and no more than 14 units a week. With regard to FASD, any alcohol use during pregnancy is considered risk drinking.
impulse is a sudden spontaneous inclination or incitement to some
usually unpremeditated action. It is a force that often produces sudden
motion, which sometimes is inhibited. For example, an individual might
swing at another person who bumps into him or her by accident or a
child may have an impulse to run away and may run away or resist the
impulse and not run away.
involves the failure to resist an impulse, drive or temptation to
perform an act (e.g., an angry outburst, inappropriate touching) in a
situation that may be damaging to the person or others. Impulsivity can
result from a number of causes.
The incidence rate is the rate at which new events occur in a population.
prevention efforts target high-risk individuals who have signs or
symptoms of a condition or have biological markers indicating
predisposition. Targets of indicated prevention include women who abuse
alcohol, such as women who binge drink while pregnant, particularly
pregnant or preconceptional women who drink alcohol and have already
given birth to children with an FASD. Substance abuse treatment for
pregnant women is a form of indicated prevention.
disorders are genetic disorders caused by a genetic or chromosomal
abnormality in a parent that is transmitted to a child (e.g., Fragile X
syndrome). FASD cannot be inherited. However, people with an FASD can
have children with an FASD if they drink during pregnancy.
disabilities (LD) are identified difficulties with reading, writing,
spelling, computing or communication. LD affects people’s ability to
either interpret what they see and hear or to link information from
different parts of the brain. These limitations can show up in many
ways, as specific difficulties with spoken and written language,
co-ordination, self-control or attention. Such difficulties extend to
schoolwork and can impede learning to read, write or do maths.
to current growth charts, low birthweight is a weight below 2,500gm (5lb 5oz) at
the time of birth. This standard may need to be revised to reflect
variations among different racial and ethnic groups.
Major depressive disorder is marked by a depressed mood or a loss of
interest or pleasure in daily activities consistently for at least 2
weeks. This mood must represent a change from the person’s normal mood;
social, occupational, educational or other important functioning must
also be negatively impaired by the change in mood. In children and
adolescents, this mood may be demonstrated by irritability.
Mental health disabilities
disabilities are a diverse group of physical, cognitive, psychological,
sensory and speech impairments that begin any time during development
up to 18 years of age.
retardation is a disorder characterised by a significantly
below-average score on a test of intellectual ability and limitations
in such areas as self-direction, school, work, leisure activities,
daily living and social and communication skills. About 27 percent of
individuals with FAS and 9 percent with FAE meet intelligence quotient
(IQ) criteria for mental retardation (70 or below).
is a congenital anomaly of the CNS where the head circumference is more
than 3 standard deviations below the mean for age and sex.
is a relative term describing the small size of the lower jaw. In true
micrognathia, the jaw is small enough to interfere with feeding of an
infant and may require special nipples in order to feed adequately.
Motivational interviewing (MI)
is a structured brief intervention procedure for people with substance
use problems. It includes clinician empathy and advice, feedback,
establishment of client responsibility, determination of options and
encouragement of the client’s self-efficacy in changing behaviour.
refers to withdrawal symptoms at birth among infants born with a
substance such as cocaine, heroin or alcohol in their bodies at high
levels. Symptoms include tremors (trembling), irritability (excessive
crying), sleep problems, high-pitched crying, tight muscle tone,
hyperactive reflexes, seizures, yawning, stuffy nose and sneezing, poor
feeding and suck, vomiting, diarrhoea, dehydration, sweating and fever
or unstable temperature.
defiant disorder (ODD) is defined by the Diagnostic and Statistical
Manual of Mental Disorders, fourth edition (DSM-IV), as a recurring
pattern of negative, hostile, disobedient and defiant behaviour in a
child or adolescent, lasting for at least six months without serious
violation of the basic rights of others.
fissures are eye openings. People with FAS have short palpebral
fissures. The palpebral fissure is measured from the inner canthus
(corner) of the eye to the outer canthus of the eye. Short palpebral
fissures usually measure below –2 standard deviations for age.
relation to births, parity refers to the number of viable pregnancies a
woman has had to the 20th week, regardless of the outcome. Studies have
shown that women with drinking problems and greater parity are more
likely to produce offspring with FAS, particularly as maternal age
Partial FAS (pFAS)
FAS is a term used to describe a cluster of problems in individuals who
are known to have faced significant prenatal exposure to alcohol and
have some signs of FAS. These include some of the characteristic facial
abnormalities associated with FAS and evidence of one other component
of FAS: growth deficiency , neurodevelopmental abnormalities or
behavioural or cognitive abnormalities unexplained by family background
Perinatal pertains to events occurring after the 28th week of pregnancy through the 28th day after birth.
involves doing the same thing over and over (e.g., repeating a motor
movement, talking about one topic and not being able to change focus).
Pervasive developmental disorder
primary features of pervasive developmental disorder are severe and
pervasive impairment in the development of reciprocal social
interaction. This is associated with impairment in either verbal or
nonverbal communication skills or with the presence of stereotyped
behaviour, interests and activities.
philtrum is the vertical groove between the nose and the middle part of
the upper lip. Individuals diagnosed with FAS have a flattening of the
placenta is the organ that allows nutrients and oxygen in the mother’s
blood to pass to the fetus and metabolic waste and carbon dioxide from
the fetus to cross in the other direction. The two blood supplies do
not mix. When a mother drinks during pregnancy, the alcohol crosses the
placenta to the fetus.
care involves medical care and monitoring received during pregnancy.
Prenatal care is necessary for healthy pregnancies, particularly for
women with alcohol or drug issues, poor nutrition or medical illnesses
and women who take medication.
Prenatal exposure to alcohol (PEA)
PEA refers to the exposure of a fetus to alcohol through maternal drinking during pregnancy.
prevalence of a disorder is the number of instances of the disorder in
a given population at a designated time. The prevalence of FASD is
estimated to be 10 per 1,000 live births.
is the protection of health through personal and communitywide efforts.
FASD is 100 percent preventable if women do not drink while pregnant.
disabilities are functional deficits that reflect the CNS damage
inherent in FASD (e.g., low IQ, disabilities in reading and maths,
problems in adaptive functioning).
individual with problem drinking has issues concerning alcohol use and
may require treatment to manage the problem. Women of childbearing age
who are problem drinkers require intervention to increase the chances
of abstinence during pregnancy and the birth of a healthy child.
Factors that reduce risk of an adverse outcome, such as a stable home.
A psychometric test is any standardised procedure for measuring sensitivity, memory, intelligence, aptitude, personality, etc.
Reactive attachment disorder of infancy or early childhood
essential feature of reactive attachment disorder is markedly disturbed
and developmentally inappropriate social relatedness in most contexts
that begins before age 5 and is associated with grossly pathologic
care. Children with reactive attachment disorder may be excessively
inhibited, hypervigilant or highly ambivalent in response to
caregivers or may exhibit indiscriminate sociability or a lack of
selectivity in the choice of attachment figures. Children with an FASD
who are adopted or in foster care may be diagnosed with reactive
attachment disorder; however, whether the disturbed pattern of social
relating is due to brain damage or environmental causes remains unknown.
care is care for an individual by a person other than the usual
caregiver as a form of rest or relief for the caregiver. Respite care
is an important service for caregivers of individuals with an FASD due
to their high needs.
With regard to FASD, any alcohol use during pregnancy is considered
risk drinking. Non-pregnant women should not drink more than 2-3 units a day or more than 14 units a week. Effective screening tools are
an essential part of women’s health care to assess risk drinking.
Effective screening tools look at any alcohol use, along with some
problem drinking patterns. These tools are typically brief, with good
specificity and sensitivity. Examples are the AUDIT, AUDIT-C, TWEAK,
T-ACE, 4 P’s and CAGE.
Risk factors are traits or habits that make a person more likely to
develop disease or to engage in a potentially harmful behaviour. Risk
factors for drinking during pregnancy include a family history of
alcohol abuse and a partner who drinks heavily.
is a brain disorder usually diagnosed during the teen or early adult
years. In rare cases, schizophrenia is diagnosed in children. The
symptoms of schizophrenia are usually divided into two categories:
positive and negative. “Positive” refers to overt symptoms that should
not be there, such as delusions and hallucinations. “Negative” refers
to a lack of characteristics that should be there. Negative symptoms
include emotional flatness, inability to start and complete tasks,
brief speech that lacks content and lack of pleasure or interest in
life. Symptoms of schizophrenia may overlap with other disorders, such
as bipolar disorder. Persons whose symptoms cannot be clearly
categorised are sometimes diagnosed as having a “schizoaffective
screening is a question-based method for identifying individuals who
drink alcohol, drink at risk levels, drink heavily or have alcoholism.
Alcohol screening is extremely important for pregnant women to ensure
that they receive appropriate interventions to help them stop drinking.
Alcohol screening is also important for all women of childbearing age
to identify those drinking at levels associated with health problems.
Drinking more than seven drinks per week or four or more drinks at one
time in the past 30 days is associated with health problems.
disabilities are specific problems that may arise after birth in
individuals with an FASD. They may be ameliorated through better
understanding of the disorder, early identification and appropriate
early interventions. Secondary disabilities associated with FASD
include disrupted school experiences, trouble with the law, confinement
in mental health/substance abuse treatment/criminal justice facilities,
inappropriate sexual behaviour, substance abuse disorders, dependent
living and problems with employment.
prevention targets people who are at greater risk for a particular
outcome because they are members of a subgroup known to be at higher
risk than the general population. Targets of selective FASD prevention
include women of childbearing age who drink alcohol. Alcohol screening
and brief interventions are forms of selective prevention.
sensitivity of a screening test is the proportion of truly disordered
persons in the screened population who correctly test positive.
integration is the involuntary process by which the brain assembles a
picture of our environment at each moment in time using information
from all of our senses. Children with learning disabilities or autism
have difficulties with sensory integration.
Sensory integration (SI) dysfunction
dysfunction is a neurologic disorder involving the inefficient brain
processing of information received through the senses. People with SI
dysfunction experience problems with learning, development and
Social perceptual problems
in social perception involve the lack of awareness of the consequences
of behaviour, conversational deficits (e.g., interrupting, poor timing)
and the inability to comprehend nonverbal communication (e.g., facial
expressions and hand gestures).
Social skills training
skills training involves a treatment package, including modelling,
behavioural rehearsal and reinforcement used to teach individuals
interpersonal competencies necessary to successfully interact with
others. Social skills training is a highly promising procedure for
individuals with an FASD and is being pilot tested.
Socio-economic status (SES)
is an individual’s social standing or condition in society determined
by both income and employment status. For example, a physician usually
has a high SES.
The specificity of a screening test is the proportion of those without disease who correctly test negative.
abuse treatment is a therapeutic programme, staffed by addiction
professionals, for individuals with alcohol or drug problems. It may
involve inpatient or outpatient care.
of a disorder involves ongoing monitoring of all aspects of the
disorder’s occurrence and its spread pertinent to effective control.
FASD surveillance through hospital discharge records, birth defect
registries, studies of infants of mothers who drink and screening of
individuals at risk of an FASD in the community is used to determine
the incidence and prevalence of these disorders.
is the art of snugly wrapping a baby in a blanket for warmth and
security. It can also keep babies from being disturbed by their own
startle reflex and it may help them stay warm for the first few days
of life until their internal thermostat kicks in. Swaddling has been
shown to calm infants and some success has been reported with infants
with an FASD.
T-ACE is a screening tool for identifying pregnant women who drink
alcohol or nonpregnant women that drink at risk levels. The acronym
T - Tolerance: How many drinks does it take you to feel high?
A - Annoyed: Have people annoyed you by criticising your drinking?
C - Cut down: Have you ever felt you ought to cut down on your drinking?
E - Eye-Opener: Have you ever had a drink first thing in the morning to
steady your nerves or to get rid of a hangover?
The tolerance question is scored as 2 points if the respondent reports
needing more than two drinks to get high. This threshold can be reduced
to 2 or more drinks when screening pregnant women. This will increase
the number of women who drink any alcohol. A positive response to A, C
or E is scored as 1 point each. A score of 2 or more indicates likely
drinking during pregnancy. The T-ACE has been found to be effective in
identifying pregnant women who drink alcohol.
teratogen is any substance, such as alcohol or condition, such as
measles, that can cause damage to a fetus, resulting in deformed fetal
structures. Alcohol causes birth defects and brain damage, resulting in
neurobehavioural problems in exposed offspring.
TWEAK is a screening tool for identifying pregnant women with alcohol problems. The acronym stands for:
T - Tolerance: How many drinks can you hold?
W - Have close friends or relatives worried or complained about your drinking in the past?
E - Eye-Opener: Do you sometimes take a drink in the morning?
A - Amnesia: Has a friend or family member ever told you about things
you said or did while you were drinking that you could not remember?
K(c) - Do you sometimes feel the need to Cut Down on your drinking?
On the tolerance question, 2 points are given if a woman reports that
she can consume more than 5 drinks without falling asleep or passing
out. A positive response to the worry question yields 2 points and
positive responses to the last three questions yield 1 point each. A
score of 2 signals an at-risk drinker. TWEAK has been found to be
highly sensitive in identifying women who are at-risk drinkers.
prevention strives to ensure that all members of society understand
that a behaviour, such as drinking alcohol during pregnancy, can have
hazardous consequences. Mass media campaigns to the general public over
radio and TV are examples of universal prevention.
Withdrawal refers to a group of symptoms that may occur from suddenly
stopping the use of an addictive substance such as alcohol after
chronic or prolonged ingestion. People who have withdrawal symptoms
after stopping alcohol use, may have problems with alcohol dependence.