Using brief interventions in a community setting for heavy-drinking women of child-bearing age
Regarding Fetal Alcohol Syndrome. As you point out in your article, "The New Thalidomide," that FAS children are born to heavy drinking women and generally these women are not upper middle class white women. I agree that this is true. However, here in the Yukon Territory, Canada, alcohol is part of the frontier mentality, although our dominant white middle class scapegoat the problem of FAS onto the First Nation community. Even today 1890's gold rush ladies (white women) with revealed breasts holding glasses of wine grace our main street store windows. The Yukon bureau of stats reveals that white men in their 20-40's statistically are the ones drinking and driving. Guys who drink lots live with women who drink. As in your article we have extremely poor access to pre/post natal care, preconception care, and informed birth control options. We have violence, unemployment and lack of opportunity. With these odds we are sending out 1000 canvas bags containing preconception, conception, and parenting materials. What would you follow the bags with? Living here, where would you focus your energy? What would you ask of your governments? And, anyone with great resources or suggestions we are interested in networking (non punitive and non-AA approaches).
Packets themselves can help some people, but are not likely to have the overall impact you seek. I think the model that may work is "brief interventions." This requires informing and training existing community health care workers in such interventions, which have the following components:
- raising the question of drinking with all women of childbearing age;
- systematic assessment of consumption, degree of dependence, psychosocial functioning;
- educational counseling sessions with the individual and family, including
- acceptance of responsibility
- self-help manuals (or, alternately, give out your packets HERE);
- periodic follow-up of behavior, physical indicators, progress towards goals.
[Brief intervention strategies are described in the Handbook of Alcoholism Treatment Approaches]
This creates a treatment alliance with a sympathetic and respected health-care worker. Materials embedded in this type of ongoing relationship will have the greatest impact. As far as government assistance, you could seek their aid in creating a community training program for health care workers in brief intervention techniques.