Screening Tools in Pregnancy

4 Ps Plus (54)

  • The 4Ps Plus is a screening tool that was developed for use and has been validated for use in obstetric settings.  An answer of yes is a positive screen and warrants more detailed questions1
    Parents: Did any of your parents have a problem with alcohol or other drug use?
    Partner: Does your partner have a problem with alcohol or drug use?
    Past: In the past, have you had difficulties in your life because of alcohol or other drugs, including prescription medications?
    Pregnancy In the month before pregnancy, have you drunk any alcohol or used any other drugs?
  • An answer of yes to any of these questions should prompt further questions.

What if the screen is positive?

  • A positive screen for drug use should trigger a more detailed conversation with the patient regarding patterns of use

Screening, Brief Intervention, Referral to Treatment (SBIRT)

  • Screening, Brief Intervention, and Referral to Treatment (SBIRT) was developed by The Center for Substance Abuse Treatment as an evidence-based method for identifying at-risk alcohol and substance use 2, 3
  • Screening is performed using a validated, standardized screening tool 2
  • Brief intervention is initiated for patients who screen positive based on the tool
    Can consist of a 3-5 minute conversation or more in-depth counseling
  • Referral to treatment consists of providing the patient with additional treatment resources
  • Multiple randomized controlled trials have demonstrated the efficacy of integration of SBIRT into primary care settings in reducing alcohol use4
  • Additional information can be found at
  1. Chasnoff IJ et al (2007). Validation of the 4p’s plus© screen for substance use in pregnancy. Journal of Perinataology 27. 774- 748
  2. SBIRT: Screening, Brief Intervention, and Referral to Treatment.  Retrieved January 15, 2014 from The Substance Abuse and Mental Health Services Administration Web site:
  3. Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol Series 2009: 09-4226.
  4. Moyer, A. et al (2002).  Brief interventions for alcohol problems; a meta-analytic review of controlled investigations in treatment-seeking and non-treatment seeking populations. Addiction 97. 279-292.

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January, 2014