title: Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management.
abstract: In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM) was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI) techniques and the Community Reinforcement Approach (CRA). Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD.
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa. pmay@email.unc.edu.
authors.forename: Marlene M
authors.initials: MM
authors.lastname: de Vries
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa. bjoubert@sun.ac.za.
authors.forename: Belinda
authors.initials: B
authors.lastname: Joubert
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa. lcloete@sun.ac.za.
authors.forename: Marise
authors.initials: M
authors.lastname: Cloete
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa. sumien@sun.ac.za.
authors.forename: Sumien
authors.initials: S
authors.lastname: Roux
authors.affiliation: Center on Alcoholism, Substance Abuse, and Additions (CASAA), The University of New Mexico, Albuquerque, NM 87106, USA. babaca@unm.edu.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Baca
authors.affiliation: Gillings School of Global Public Health, Department of Nutrition, Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA. julie_hasken@unc.edu.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Hasken
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa. ronelb07@gmail.com.
authors.forename: Ronel
authors.initials: R
authors.lastname: Barnard
authors.affiliation: Center on Alcoholism, Substance Abuse, and Additions (CASAA), The University of New Mexico, Albuquerque, NM 87106, USA. dbuckley@unm.edu.
authors.forename: David
authors.initials: D
authors.lastname: Buckley
authors.affiliation: Center on Alcoholism, Substance Abuse, and Additions (CASAA), The University of New Mexico, Albuquerque, NM 87106, USA. wkalberg@unm.edu.
authors.forename: Wendy O
authors.initials: WO
authors.lastname: Kalberg
authors.affiliation: School of Social Work, Howard University, Washington, DC 20059, USA. csnell@howard.edu.
authors.forename: Cudore L
authors.initials: CL
authors.lastname: Snell
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa. asmarais@sun.ac.za.
authors.forename: Anna-Susan
authors.initials: AS
authors.lastname: Marais
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa. sseedat@sun.ac.za.
authors.forename: Soraya
authors.initials: S
authors.lastname: Seedat
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa. cparry@sun.ac.za.|Tobacco &amp; Other Drug Research Unit, Medical Research Council of South Africa, Alcohol, Tygerberg 7505, South Africa. cparry@sun.ac.za.
authors.forename: Charles D H
authors.initials: CD
authors.lastname: Parry
authors.affiliation: Center on Alcoholism, Substance Abuse, and Additions (CASAA), The University of New Mexico, Albuquerque, NM 87106, USA. mmdevries@sun.ac.za.|Gillings School of Global Public Health, Department of Nutrition, Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA. mmdevries@sun.ac.za.
authors.forename: Philip A
authors.initials: PA
authors.lastname: May
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D019090:Case Management; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008425:Maternal Behavior / Q000523:psychology; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
keywords: South Africa; alcohol exposure; case management; fetal alcohol spectrum disorders; happiness; pregnancy; reduction in alcohol consumption