Curriculum for Addiction Professionals (CAP): Level 1

Glossary

Term	Definition

A
Abstinence	Abstinence means not drinking any alcoholic beverage, including beer, wine, and hard liquor. It is recommended that all pregnant women abstain from alcohol to avoid fetal damage.
Abstract thinking	Abstract thinking, or abstracting, often thought to develop around the age of 11 in 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.
Addiction	Addiction 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.
Alcohol	Alcohol is a drink containing the substance ethanol.
Alcohol dependence	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 12-month period: Tolerance 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 recognized psychological or physical consequences. Pregnant women who are alcohol dependent are at risk of delivering a child with an FASD.
Alcohol screening	Alcohol screening is a question-based method for identifying individuals with alcohol problems and assessing the severity of use. Alcohol screening is extremely important for pregnant women to ensure that they receive appropriate interventions to help them deliver healthy infants. Alcohol screening is also important for all women of childbearing age.
Alcoholism	Alcoholism 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 behavior. 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 hearing abnormalities.
Alcohol-related neurodevelopmental disorder (ARND)	ARND, a term coined by the Institute of Medicine in 1996, is used to describe individuals with confirmed maternal alcohol use, neurodevelopmental abnormalities, and a complex pattern of behavioral 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.
Americans with Disabilities Act (ADA)	The ADA is a Federal law that prohibits discrimination on the basis of disability in employment, State and local government, public accommodations, commercial facilities, transportation, and telecommunications. An individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. The ADA does not specifically name all of the impairments that are covered.
AUDIT	The Alcohol Use Disorders Identification Test (AUDIT) is a simple ten-question test developed by the World Health Organization to determine if a person's alcohol consumption is excessive. WHO designed the test for international use and it was validated in a six-country study. Questions 1-3 deal with alcohol consumption, 4-6 relate to alcohol dependence and 7-10 consider alcohol related problems. A score of 8 or more in men (7 in women) indicates a strong likelihood of hazardous or harmful alcohol consumption. A score of 13 or more is suggestive of alcohol related harm.
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B
Behavior problems	A behavior problem involves unusual or age-inappropriate behavior 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 emotional problems).
Binge drinking	Binge drinking generally refers to the consumption of four or more drinks in about 2 hours. Binge drinking during pregnancy can result in FASD.
Bipolar disorder	Bipolar 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 behavior 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 behavior rather than the euphoria often seen in adults.
Birth defect	A 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 environmentally induced.
Brief intervention	A brief intervention is approximately one to four therapy sessions delivered to individuals with problem drinking and other problematic behaviors. The intervention may include advice to abstain from alcohol use or decrease alcohol consumption to below risk drinking levels, brief counseling, goal setting, and development of action plans.
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C
CAGE	The CAGE is a screening tool for identifying risk drinkers. The acronym stands for: C—Have you ever felt you ought to Cut Down on your drinking? A—Have people ever Annoyed you by criticizing your drinking? G—Have you ever felt bad or Guilty about your drinking? E—Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-Opener)? Each positive answer is scored as 1 point. A score of 2 or more points is considered evidence of possible risk drinking. The CAGE has been used effectively to identify alcoholic clients, but it may not be as sensitive as other brief scales with female populations.
Central nervous system (CNS) impairments	The CNS consists of the brain and spinal cord and coordinates the activity of the entire nervous system. CNS impairments include lack of coordination, cognitive deficits, and impaired judgment.
CNS abnormalities	CNS 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 fibers that connect the right and left brain hemispheres). CNS functional abnormalities are abnormal or age-inappropriate behaviors that are assumed to be related to structural brain damage (e.g., newborn jitteriness, hyperactivity, attention problems, memory impairments).
Cognitive-behavioral therapy	In the field of substance abuse treatment, cognitive-behavioral therapy is an approach that includes self-management and relapse prevention strategies. It is designed to help individuals stop or reduce alcohol consumption by observing their drinking behavior, setting behavioral objectives, or training in skills to handle conflicts or stress without resorting to drinking.
Conduct disorder	The essential feature of conduct disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms or rules are violated. These behaviors may involve aggressive conduct that causes or threatens physical harm to other people or animals, the deliberate destruction of property, deceitfulness or theft, and serious violations of rules. Some individuals with an FASD may be diagnosed with conduct disorder. This could be a co-occurring disorder for some. Others may demonstrate what looks like conduct disorder but may actually be a result of having difficulty understanding rules and requests. They may be misdiagnosed with conduct disorder.
Congenital defects	Congenital defects are imperfections with which a person is born, acquired during development in the uterus. The defects may be due to genetics or to fetal injury or insult (e.g., maternal alcohol use or infection). Infants with an FASD may be born with congenital defects (e.g., heart defects, limb and joint abnormalities).
Contraception	Contraception is any means of preventing pregnancy. It is advocated for use by women who cannot or do not choose to stop consuming alcohol during childbearing years in order to prevent an FASD.
Co-occurring	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.
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D
Depression	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.
Developmental disabilities	Developmental 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.
Diagnosis	Diagnosis is the process of determining disease status through the study of symptom patterns and the factors responsible for producing them.
Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code	The 4-Digit Diagnostic Code was developed by the FAS Diagnostic and Prevention Network at the University of Washington in response to the need to standardize 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, neurobehavioral disorder, or no detected cognitive or physical findings. The 4-Digit Diagnostic Code has shown excellent consistency and reliability.
Dysmorphology, dysmorphologist	Dysmorphology is a term coined by the late Dr. David W. Smith for the study of human congenital malformations. A dysmorphologist is a clinician that specializes in this field.
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E
Ethnicity, ethnic background	Ethnicity refers to racial, national, tribal, religious, linguistic, or cultural origin or background. Rates of FASD vary among ethnic groups. For example, some Native American populations have higher rates of FASD than the general population.
Executive functioning deficits	Executive function deficits, which are often attributed to dysfunction in the frontal lobe of the brain, primarily involve difficulty forming, planning, and carrying out goal-directed activities. Executive functions also include the ability to change behaviors in different situations.
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F
Facial anomalies	FAS facial anomalies or abnormalities are a pattern of abnormal facial features including short palpebral fissures, thin upper lip, and flattened philtrum.
Failure to thrive	Failure 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.
FAS facial phenotype	The FAS facial phenotype is one of the diagnostic criteria in the 4-Digit Diagnostic Code developed by the FAS Diagnostic and Prevention Network at the University of Washington. Three features (palpebral fissure length, philtrum smoothness, and upper lip thinness) are measured to document the magnitude of expression of the FAS facial phenotype.
FASD screening	FASD screening is a technique that uses a variety of tools to identify individuals who show signs of an FASD in infancy and early childhood or who are known to have had prenatal alcohol exposure. It can also be used to identify adolescents and adults who may have the disorder and have not been previously diagnosed.
Fetal alcohol spectrum disorders (FASD)	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, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis.
Fetal alcohol syndrome (FAS)	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.
Fetus	A 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.
Free and appropriate public education (FAPE)	Children with disabilities are entitled to a FAPE in the least restrictive environment appropriate to their individual needs, according to the Individuals with Disabilities Education Act (IDEA).
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G
Genetic disorders	Genetic 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 hemophilia and mental retardation (e.g., Down syndrome).
Gestational age	Gestational age is the time measured from the first day of the woman's last menstrual cycle to the current date. It is measured in weeks.

H
Health Insurance Portability and Accountability Act (HIPAA)	Established in 1996, HIPAA requires the Department of Health and Human Services to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addresses the security and privacy of health data.
Heavy drinking	Heavy drinking generally refers to the consumption of five or more drinks on the same occasion on 5 or more days in the past month. Heavy drinking during pregnancy can result in an FASD.
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I
Impulse	An 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.
Indicated prevention	Indicated prevention efforts target high-risk individuals who have signs or symptoms of a condition or have biologic 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.
Individualized education plan (IEP)	An IEP is a blueprint for a child’s special education needs and related services. All public school children who receive special education must have an IEP. By law, certain individuals must be involved in writing a child’s IEP, including teachers, parents, school administrators, related services personnel, and students (when appropriate).
Individuals with Disabilities Education Act (IDEA)	IDEA (formerly the Education for all Handicapped Children Act of 1975) requires public schools to make available to all eligible children with disabilities a free and appropriate public education in the least restrictive environment appropriate to their individual needs. The Act was amended most recently in 2004.
Institute of Medicine (IOM) Diagnostic Criteria for FAS and Alcohol-Related Effects	The 1996 IOM diagnostic criteria for FAS were developed to refine definitions and enhance the consistency of the terminology used to describe varying effects of prenatal alcohol exposure. The criteria use a gestalt procedure in which experienced clinicians determine the degree to which the individual meets the specified criteria for FAS (with or without confirmed maternal alcohol exposure), partial FAS, ARBD, and ARND.
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L
Learning disabilities	Learning 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, coordination, self-control, or attention. Such difficulties extend to schoolwork and can impede learning to read, write, or do math.
Low birth weight	According to current growth charts, low birth weight is a weight below 5 pounds at the time of birth. This standard may need to be revised to reflect variations among different racial and ethnic groups.
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M
Medicaid	Medicaid is a program that provides medical benefits to certain low-income individuals and families. Although the Federal government establishes general guidelines for the program, Medicaid eligibility and services are established by each State.
Mental retardation	Mental retardation is a disorder characterized 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 fetal alcohol effects meet intelligence quotient (IQ) criteria for mental retardation (70 or below).
Metabolism	Alcohol 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.
Microcephaly	Microcephaly is a congenital anomaly of the CNS where the head circumference is more than 3 standard deviations below the mean for age and sex.
Motivational interviewing (MI)	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 behavior.
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N
Neurodevelopmental abnormalities	Neurodevelopmental abnormalities are CNS abnormalities, such as small head size at birth, and structural brain abnormalities leading to impaired fine motor skills, hearing loss, gait problems, and poor eye-hand coordination.
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O
Oppositional defiant disorder (ODD)	The essential feature of ODD is a recurrent pattern of negative, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months. Physical aggression is not typically seen in those with ODD. Some individuals with an FASD may be diagnosed with ODD, which could be co-occurring ODD. Others may seem oppositional but may not understand the request made or be able to follow multiple directions. They may be misdiagnosed with ODD.
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P
Palpebral fissures	Palpebral 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.
Partial FAS (pFAS)	Partial 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 behavioral or cognitive abnormalities unexplained by family background or environment.
Philtrum	The 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 philtrum.
Placenta	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.
Postnatal	Postnatal refers to events occurring after birth.
Prenatal	Prenatal refers to events existing or occurring before birth.
Prenatal care	Prenatal 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), prenatal alcohol exposure	PEA refers to the exposure of a fetus to alcohol through maternal drinking during pregnancy.
Prevalence	The 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 at least 10 per 1,000 live births.
Prevention	Prevention is the protection of health through personal and communitywide efforts. FASD is 100 percent preventable if women do not drink while pregnant.
Problem drinking	An 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.
Psychometric Testing	A psychometric test is any standardized procedure for measuring sensitivity, memory, intelligence, aptitude, personality, etc.
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R
Reactive attachment disorder	The 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.
Residential treatment	Residential treatment is a living setting designed for individuals who have difficulty living with family or on their own due to physical problems, developmental disabilities, or mental illness. It provides adult supervision, therapy, and skills training in a large or small group setting. Residential treatment may be necessary for some children, adolescents, and adults with an FASD, as they may be unable to live successfully in the community without supervision.
Respite care	Respite 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.
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S
Schizophrenia	Schizophrenia 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 categorized are sometimes diagnosed as having a “schizoaffective disorder.”
Secondary disabilities	Secondary 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 behavior, substance abuse disorders, dependent living, and problems with employment.
Sensitivity	The sensitivity of a screening test is the proportion of truly disordered persons in the screened population who correctly test positive.
Sensory integration (SI) dysfunction	SI 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 behavior.
Social perceptual problems	Problems in social perception involve the lack of awareness of the consequences of behavior, conversational deficits (e.g., interrupting, poor timing), and the inability to comprehend nonverbal communication (e.g., facial expressions and hand gestures).
Social Security Disability Insurance (SSDI)	Social Security Disability Insurance (SSDI) is a Federal program that provides monthly payments to eligible workers and certain members of their families. To be eligible, the worker must be “insured,” meaning that he or she worked long enough and paid Social Security taxes. Disability benefits are payable to blind or disabled workers, widow(er)s, or adults disabled since childhood, who are otherwise eligible. The amount of the monthly disability benefit is based on the Social Security earnings record of the insured worker.
Social skills problems	Social skills deficits involve difficulty in effectively interacting and communicating with others, especially in developing and keeping friendships.
Specificity	The specificity of a screening test is the proportion of those without disease who correctly test negative.
Stages of change theory	A model of the stages of readiness for behavioral change, composed of precontemplation, contemplation, preparation, action, maintenance, and relapse. Counselors can use motivational interviewing to help clients make decisions for themselves along the stages of change.
Standard drink	Because alcoholic beverages vary in alcohol concentration, drinks are designated by a standard drink conversion. One standard drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounce of hard liquor. All have the same equivalency of 0.48 ounces of absolute alcohol.
Strategic Prevention Framework	SAMHSA’s Strategic Prevention Framework is a systemic community-based approach that aims to ensure that substance abuse prevention programs produce results. The framework uses the findings from public health research along with evidence-based prevention programs to build capacity within States and the prevention field.
Substance abuse treatment	Substance abuse treatment is a therapeutic program, staffed by addiction professionals, for individuals with alcohol or drug problems. It may involve inpatient or outpatient care.
Sudden infant death syndrome (SIDS)	SIDS is the sudden death of an infant less than 1 year of age that cannot be explained by information collected during a thorough investigation.
Supplemental Security Income (SSI)	SSI is a Federal income supplement program funded by general tax revenues and administered by Social Security. It is designed to help people with limited income who are disabled, blind, or over 65 by providing monthly benefits to meet basic needs for food, clothing, and shelter. Disabled children, as well as adults, can receive SSI benefits.
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T
T-ACE	T-ACE is a screening tool for identifying pregnant women with alcohol problems. The acronym stands for: T—Tolerance: How many drinks does it take you to feel high? A—Annoyed: Have people annoyed you by criticizing 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 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. 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 consumed sufficient amounts of alcohol to endanger a fetus.
Teratogen, teratogenic	A 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 neurobehavioral problems in exposed offspring.
Trimester	A trimester is a 3-month period during pregnancy. Pregnancy is divided into three trimesters. Alcohol-related damage to a fetus can occur anytime during a pregnancy. Specific problems can occur during each trimester. For example, alcohol exposure during the first trimester can cause FAS facial features. Heavy drinking during the second trimester increases the risk of miscarriage. Drinking during the third trimester may lead to neurodevelopmental abnormalities and growth retardation. Effects on brain development can occur in any trimester of pregnancy.
TWEAK	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.
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U
Universal prevention	Universal prevention strives to ensure that all members of society understand that a behavior, 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.
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V
Vocational rehabilitation	Vocational rehabilitation comprises services that help eligible individuals achieve employment, such as vocational counseling and referral, job training, and job placement. States receive Federal grants to operate a comprehensive vocational rehabilitation program.
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