Motivational interventions in prenatal clinics.

Although the risks associated with pregnancy are well-documented, prevention efforts, for the most part, have not reached women who drink at levels that present the greatest risk. Recent clinical studies and demonstration projects show that interventions by obstetric caregivers can help reduce drinking even among women who consume alcohol at the heaviest levels. Brief interventions and motivational interviewing are two approaches that can be adapted for busy medical offices to provide interventions before, during, and after pregnancies. By combining these interventions with a stepped-care approach, practitioners will be able to intervene to prevent drinking during pregnancy while minimizing costs to the patient and demands for limited clinic resources.

Findings of a pilot study of motivational interviewing with pregnant drinkers.

OBJECTIVE: Cost-effective interventions are needed for counseling pregnant drinkers, in order to reduce risk of fetal alcohol effects. METHOD: 42 pregnant women who reported alcohol consumption participated in this pilot study of motivational interviewing. Following a comprehensive alcohol use assessment, the participants were randomly assigned to receive either written information about the risks related to drinking during pregnancy or a one-hour motivational interview. The motivational interview was an empathic, client-centered, but directive session focusing on the health of the participants' unborn babies. RESULTS: At the end of a 2-month follow-up period, the 34 women (81%) who remained in the study showed a significant reduction in alcohol consumption and peak intoxication levels. Women who had reported the highest blood alcohol concentration (BAC) levels during early pregnancy showed a significantly greater reduction in their estimated BACs at follow-up (during later pregnancy) if assigned to the treatment rather than the control condition. CONCLUSIONS: Motivational interviewing shows promise as a specific intervention for initiating a reduction in drinking among pregnant women who are at greatest risk. Simpler assessment and advice may suffice for women with lower initial consumption levels.

Videotaped training in alcohol counseling for obstetric care practitioners: a randomized controlled trial.

OBJECTIVE: To determine the feasibility of videotaped training for obstetric care practitioners in motivational interviewing skills that could be used in brief patient consultations on problem drinking. METHODS: Thirty health care practitioners participated in a clinical trial using a 20-minute videotape to instruct them in motivational interviewing. Participants engaged in a pretest roleplay with an actress playing a drinking pregnant woman. Those randomly assigned to the experimental condition watched the motivational interviewing videotape. Control condition participants watched a 20-minute docudrama of a pregnant problem drinker. Both groups then engaged in a post-test roleplay similar to the pretest. Behavioral ratings of the roleplays and participant evaluations of the motivational interviewing video constituted the outcome measures. RESULTS: Participant evaluations indicated that the training video was clear in explaining and demonstrating the principles and skills of motivational interviewing. Change in behavioral ratings from pretest to post-test showed significant differences in motivational interviewing skills between the experimental and control groups. Obstetric care practitioners who viewed the training video were rated as showing greater empathy, minimizing patient defensiveness, and supporting women's beliefs in their ability to change. CONCLUSION: Obstetric care practitioners can improve their alcohol intervention skills through the use of a 20-minute videotaped instruction in motivational interviewing. Clinicians who improve their skills in motivational interviewing can intervene more effectively with their drinking pregnant patients. Using motivational interviewing with this population holds promise for helping prevent alcohol-related health problems.

Specific impairments in self-regulation in children exposed to alcohol prenatally.

The present study utilizes a conceptual framework derived from theories of cognition to explain the pattern of behavioral and learning problems observed in subjects with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). Based on a modern interpretation of Luria's theory of self-regulation, this study used a neuropsychological test battery to compare 10 subjects (mean age = 13 years) having FAS/FAE with 10 control subjects (mean age = 12 years and 9 months). Subjects with FAS/FAE were relatively high functioning and did not significantly differ from controls with respect to receptive vocabulary. However, those with FAS/FAE exhibited greater difficulty than controls on tasks that involved the manipulation of information and goal management in working memory (e.g., Planning, Controlled Oral Word Association, etc). Both groups performed equally well on some tasks that demanded rule learning (Delayed Response) and response inhibition (Go-No-Go). The above impairments were interpreted to be reflective of selective rather than generalized disruptions of neural networks that subserve working memory.