The TWEAK Alcohol Screening Test

Test Designed for Pregnant Women

Pregnant Woman Drinking Wine
TWEAK Test Designed for Pregnant Women. © Getty Images

The TWEAK alcohol screening test is a short, five-question test which was originally designed to screen pregnant women for harmful drinking habits. Researchers at the Research Institute on Addictions at Buffalo, New York, Department of Obstetrics/Gynecology and Wayne State University developed the TWEAK as a short test more sensitive to detecting alcohol problems in pregnant women.

Note: Any level of drinking during pregnancy can be harmful.

Their follow-up research revealed that the TWEAK test was more effective than the T-ACE test in diagnosing harmful drinking in women.

TWEAK has also been used to screen for harmful drinking in the general population, outpatients, hospital patients, and in emergency room settings.

The test is made up of three questions which appear on the CAGE test, plus two additional questions -- one about the person's tolerance to alcohol and another about blackouts.

The name of the test is an acronym for Tolerance, Worried, Eye-opener, Amnesia, and K/Cut down (with a poetic license use of "K" instead of "C" for cutting down on alcohol consumption).

The TWEAK Test

1. How many drinks does it take to make you feel high?

2. Have close friends or relatives worried or complained about your drinking in the past year?

3. Do you sometimes take a drink in the morning when you first get up?

4. Has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?

5. Do you sometimes feel the need to cut down on your drinking?

Scoring the TWEAK Test

The maximum score on the test is seven points, with the first two questions counting for two points each and the last three one point each. Note about question 1: If a woman responds that it takes three or more drinks to feel high, she scores two points.

If she responds "less than three," she scores zero on the question.

A total score of two or more on the test is an indication of harmful drinking and further evaluation is indicated.

Sometimes the following for question is substituted for 1: "How many drinks can you hold?" If a woman responds that she can hold more than five drinks (meaning she can drink more than five without passing out), she scores two points; she scores zero if she reports less than five.

It's Important That Pregnant Women Don't Drink

The reason that a quick test designed to detect drinking problems in pregnant women is needed in primary care settings is because of the danger that drinking alcohol can have for the unborn child.

If you are pregnant and you have a drinking problem to the extent that you may need help to quit during your pregnancy, your healthcare provider needs to know so that they can provide help or refer you to a treatment program.

The health and wellfare of your baby is at stake.


National Institute on Alcoholism and Alcohol Abuse. Instrument Fact Sheets. August 2004.

Russel, Marcia, et. al. (1994). Screening for Pregnancy Risk-Drinking. Alcoholism: Clinical and Experimental Research, 18 (5): 1156-1161.

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