Addiction Medicine: Closing the Gap between Science and Practice

Populations and Settings Served. The T-ACE
was created by obstetricians and gynecologists
as a screening device for risky alcohol use
among pregnant women.^177

Clinical Utility. Research on the psychometric
properties of the T-ACE is limited. The T-ACE
can identify 88 percent of risky and non-risky
drinkers.^178 It has been found to be better at
detecting risky alcohol use relative to some other
alcohol screening instruments.* 179 In obstetric
settings, the instrument accurately measures
current prenatal consumption, pre-pregnancy
risky drinking† and lifetime DSM-III diagnosis
for addiction involving alcohol.^180

TWEAK

Developed in 1994, the five-item screening
instrument, TWEAK is an acronym for
Tolerance, Worried, Eye-openers, Amnesia and
Cut-down.^181 These words describe the
questions that measure respondents’ tolerance
level, drinking behavior and personal as well as
family attitudes towards their drinking behavior.
The “tolerance” and “worried” questions are
worth up to two points and affirmative answers
on the other three questions are one point each.
A score of three or more indicates that a
respondent may be a risky drinker.^182

TWEAK is brief and easy to score. It is
available at no cost and can be administered
through interviews, via a computer or paper and
pencil questionnaire. Training is not required or
necessary.^183

Populations and Settings Served. The
instrument originally was intended for use in
screening for risky drinking among pregnant
women.‡ 184 However, it has been used in the
general population and in outpatient, hospital
and emergency room settings.^185

• Such as the CAGE and MAST.
  † Defined as more than two drinks per drinking day.
  ‡ It should be noted that any level of drinking by

pregnant women should be considered risky alcohol
use.

Clinical Utility. Although research on the

psychometric properties of the TWEAK is

limited,^186 the TWEAK appears to be better at

identifying risky drinking in pregnant women

than some other alcohol use screening

instruments.§ 187 In one population of women in

a prenatal setting, TWEAK identified accurately

71 percent of risky drinkers and 79 percent of

non-risky drinkers.^188

In a sample of adults from the general

population, TWEAK identified accurately 79

percent of individuals with addiction involving

alcohol and 89 percent of individuals without

addiction. Respondents with a score of three or

higher were 30 times likelier to have addiction

involving alcohol than those with lower scores.

In a general population sample, TWEAK was

more accurate at identifying addiction involving

alcohol among men (83 percent) than women

(66 percent),^189 a surprising finding given that

women were the intended target population.

Alcohol Dependence Scale (ADS)

The Alcohol Dependence Scale is a 25-item

assessment instrument developed in 1984 to

identify addiction involving alcohol in adult

populations.^190 It also is useful for measuring

disease severity. The instrument covers

withdrawal and tolerance, compulsion to drink

and salience of alcohol-seeking behavior. The

ADS takes about 10 minutes to complete and

score. It can be administered through an

interview or self-administered using a computer

or paper questionnaire. Generally, a cut-off

score of nine is recommended to identify

addiction.^191

Some basic training is required to administer and

score the instrument. The ADS is copyrighted

and questionnaires and user guides are available

for a fee.^192

Populations and Settings Served. Although it

was developed for adults, the ADS has been

used in adolescent populations. It has been used

in both research and clinical settings, including

§ Such as the CAGE and MAST.