AOGS GUEST EDITORIAL Opportunity to – screen, diagnose, refer and treat? VALGERDUR RUNARSDOTTIR & INGUNN HANSDOTTIR DOI: 10.1111/aogs.12281 The findings on alcohol use among pregnant women described in the article by Stene-Larsen et al. in the December issue of 2013 (1) are extremely important and alert us to look for the lessons to be learned from it. The main aim of their study was to investigate whether mater- nal negative affectivity was associated with either light use of alcohol or binge drinking during the second trimester. The findings showed that there was indeed a relation, with increased negative affectivity raising the odds for worse drinking patterns. There was a stronger association between negative affectivity and binge drinking than with lighter alcohol use, and the association increased as the pregnancy progressed. Whether this was a causal relation, and then in which direction, could not be clarified. But perhaps that is not really the main concern here, when looking at the larger picture. The rate of drinking alcohol during pregnancy in this Norwegian population is of interest. A significant propor- tion of the cohort studied did not follow national recom- mendations to abstain from all alcohol use during pregnancy, with almost 30% consuming alcohol during the first trimester, and 10% continuing light use into the second trimester. Although the sample represents only about 28% (66 111 women) of the pregnant population in Norway invited to participate in the MoBa-study, the authors explain that the bias is towards overrepresenta- tion of more resourceful and educated women, which gives this finding even more weight, given that one would assume a higher level of knowledge of the harmful effects of alcohol drinking in this cohort. Bias due to possible underreporting of consumption follows the same trend in interpreting these findings. Additionally, these rates of alcohol use are of interest considering that the recom- mendations of prenatal health care providers are absti- nence from alcohol. What does this tell us and what is there to be said and done? We would like to elaborate on this from the stand- point of addiction medicine. Making the obvious assump- tion that no woman wants wilfully to hurt her unborn child, and most women do cease to use alcohol during pregnancy, it is of great concern that so many still do drink alcohol. Obviously, at least a proportion of women drinking alcohol during pregnancy are those who have problems in controlling their drinking, and fail to stop despite harmful consequences to themselves or others, which is one of the hallmarks of addiction. So this comes as no surprise since substance use disorder is a common disease afflicting both sexes and people of all walks of life. People with alcohol use disorder also commonly experi- ence negative affect related to their addiction; the findings of Stene-Larsen et al. confirm this link, making it even more important to address the underlying alcohol use disorder because of its consequences. The disease of addiction or alcohol use disorder is an independent dis- ease, not cured by addressing only the consequences or social aspects, but requiring specialized treatment. According to a public policy statement of the American Society of Addiction Medicine alcoholism is “a complex primary physiological disease, and neither a primary behavior disorder nor a symptomatic manifestation of any other disease process”. It requires specialized care. Pregnant women thus require specialized attention and substance use needs to be detected, addressed and approached in a non-judgmental way with the aim of preventing damage and treating the underlying addiction. Stene-Larsen et al.’s study reminds us of the impor- tance of asking and looking. In screening for substance use problems, questionnaires are useful and so are tools to assess both quantity and frequency of consumption (2). Another important aspect of assessment is asking about family history of addiction, the strongest single predictor of substance use disorders (3). Smoking is often concurrent and indicative of other addiction problems. Amongst the addicted, multiple drug use is common; both use of illegal drugs and prescription drugs such as painkillers and sedatives. Those can be detected in urine drug screening. If we as healthcare professionals do not rec- ognize the disease of addiction as an independent problem that needs specialized care, then our patients will not. Then stigma and secrecy continue. Emphasis is needed on screening and intervention, diagnosing those with alcohol use disorders with reference to the diagnostic tools of DSM 5 or ICD10. Those who meet the criteria need specialized attention and care. ª 2013 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 93 (2014) 3–5 3 A C TA Obstetricia et Gynecologica