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Screening and Modifications to Treatment
Screening and Modifications to Treatment (SMT) is a promising practice-based approach for identifying individuals with a possible FASD in residential treatment programs for substance use
disorders and modifying treatment approaches to improve outcomes. The percentage of individuals with an FASD in specialized systems of care (such as substance abuse treatment) has not
been accurately determined, as many of these individuals are not recognized or diagnosed. However, one study reported that the incidence of substance use disorders in individuals with an
FASD was 35%.1 As many of these individuals repeatedly fail in, or drop out of, substance abuse treatment due to their difficulty with typical approaches such as motivational interviewing,
group therapy, and cognitive behavioral therapy, it is imperative to modify treatment approaches if we hope to improve outcomes for these individuals and their families, as well as for the
agencies and systems that provide services to them.
For outcomes to improve, individuals need to be correctly identified and the substance abuse treatment approach should be modified based on the understanding of how their brain processes
information. The Life History Screen has been developed to assist providers in this process. Published in the International Journal of Alcohol and Drug Research in an article titled
"Screening in Treatment Programs for Fetal Alcohol Spectrum Disorders that Could Affect Therapeutic Progress,"2 the Life History Screen will require further study to assess its psychometric
utility. Modifications to treatment have been described in the Journal of Addiction Medicine in an article titled "The impact of prenatal alcohol exposure on addiction treatment."3 This
article also highlights what not to do in treatment for individuals with an FASD or other subtle cognitive impairments that affect brain functioning.
1. Streissguth, A.P., Barr, H.M., Kogan, J., & Bookstein, F. L. (1996). Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome (FAS) and Fetal
Alcohol Effects (FAE). Final Report to the Centers for Disease Control and Prevention (CDC), Seattle: University of Washington, Fetal Alcohol & Drug Unit, Tech. Rep. No. 96-06,
2. Grant, T., Novick Brown, N., Graham, J., Whitney, N., Dubovsky, D., & Nelson, L. (2013). Screening in treatment programs for Fetal Alcohol Spectrum Disorders that could affect
therapeutic progress. The International Journal of Alcohol and Drug Research, 2(3), 37-49.
3. Grant, T. M., Brown, N. N., Dubovsky, D., Sparrow, J., Ries, R. (2013). The impact of prenatal alcohol exposure on addiction treatment. Journal of Addiction Medicine, 7(2), 87-95.
All SMT programs were funded in 2012 and were unable to complete their programs due to funding cuts after the first year.