The TWEAK Alcohol Screening Test

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The TWEAK alcohol screening test is a short, five-question test that was originally designed to screen pregnant women for harmful drinking habits. 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).


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 that's designed to be more sensitive to detecting alcohol problems in pregnant women. Follow-up research revealed that the TWEAK test may be more effective than the Tolerance, Annoyed, Cut-down, and Eye-Opener (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 TWEAK Test

The test is made up of three questions that also appear on the CAGE test, one of the oldest alcohol screening tests, plus two additional questions—one about your tolerance to alcohol and another about blackouts. The questions on the TWEAK test include:

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?


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 you respond that it takes three or more drinks to feel high, you score two points. If you respond "less than three," you score 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 is substituted for question 1: "How many drinks can you hold?" If you respond that you can hold more than five drinks (meaning you can drink more than five without passing out), you score two points; you score zero if you report less than five.

Why 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 that of the danger that drinking alcohol can have for your unborn child. If you're pregnant and you have a drinking problem, your healthcare provider needs to know so that he or she can provide help or refer you to a treatment program. The health and welfare of your baby are at stake.

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By Buddy T
Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism.