“You don’t want to go on a date with me, do you?”
There’s no good way to answer this question. If I do want to go on a date, I’m actually disagreeing with the person asking me. If I don’t, well, you know…saying “You’re correct. I don’t,” is hard.
I refer to this as the eighth grader asking for a date.
But, what happens when it’s not an eighth grader and it’s not a date? What happens when it’s my doctor asking me how much I drink?
We’ve all likely been subject to the questions about domestic abuse, but, in my mind, the questions about substances I use are more nebulous. Still, when they are asked, if they are asked, they’re asked in the same way: “You don’t drink much, do you?” “You don’t use illegal drugs, right?”
You’re never going to get an honest answer from these questions.
But, Screening, Brief Intervention, and Referral to Treatment, SBIRT, works…and it works for pregnant women, too…sorta. In fact, “Several studies have found SBIRT to be effective for those who misuse alcohol. Based on a review of the literature, the U.S. Preventive Services Task Force (USPSTF) found ‘good evidence that screening in primary care settings can accurately identify patients [including pregnant women] whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence, but place them at risk for increased morbidity and mortality’” (SAMHSA).
On the other hand, “Based on the scant availability of published research on SBIRT for drug use, USPSTF (2008) concluded that the evidence regarding screening for illicit drug use was inadequate to evaluate the balance of benefits” (SAMHSA).
So, what this means is that SBIRT, that is, screening, brief intervention, and referral to treatment, works if someone isn’t at the point of having the disease of addiction and if the substance used is alcohol…and only if it’s alcohol. There are no proven benefits to SBIRT if an illicit drug is being used…and for these purposes, we’re going to consider cannabis an illegal drug.
But, here’s another point: it’s only as good as the person asking the questions and the questions being asked. If the person doing the screening is uncomfortable doing the screening, ze isn’t going to ask questions properly. For example, one of the AUDIT-C questions is “How often did you have 6 or more (for men) or 4 or more (for women and everyone 65 and older) drinks on an occasion in the past year?” But if a person isn’t trained to ask these questions, it will turn into “You haven’t had 6 or more drinks during an occasion in the past year, right?”
So SBIRT works IF the substance consumed is alcohol and IF the person asking the questions is trained to ask them properly and IF the person is not addicted. And those are big IFs.
So what happens when there’s a baby involved? When we ask about substance use during pregnancy, there are a lot of factors that have to be just right: the substance can only be alcohol, the person asking the questions has to know how to ask, and the pregnant woman can’t be addicted.
Those first two asks are hard enough because it’s hard to think that someone might be using alcohol during pregnancy…a time when there’s no safe amount that can be used. And that makes asking the screening questions difficult. We can’t imagine that a pregnant woman would be drinking alcohol, so instead of asking, as the AUDIT requires, “How many drinks containing alcohol do you have on a typical day when you are drinking?” we instead say, “You’re not drinking, right?”
Then consider that pregnant women, too, have the disease of addiction. We know that addiction is the disease that only the person afflicted can address, but what about when another life is affected?
Testing matters, especially with pregnant women, because asking about substance use isn’t getting us the truth, especially IF the substance consumed isn’t alcohol, IF the person asking the questions isn’t asking them properly, and IF the person asked has addiction. On the other hand, “The detection window [for umbilical cord tissue] is up to approximately 20 weeks with extensive panel options including alcohol and heroin detection that is superior to any other newborn specimen on the market” (USDTL).
Don’t babies deserve the best start in life? Testing, rather than merely asking about use, gives them that.
References
Guided by Guida 
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