Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management. International Journal of Environmental Research and Public Health, December 23, 2015. Marlene M. de Vries 1, Belinda Joubert 1, Marise Cloete 1, Sumien Roux 1, Beth A. Baca 2, Julie M. Hasken 3, Ronel Barnard 1, David Buckley 2, Wendy O. Kalberg 2, Cudore L. Snell 4, Anna-Susan Marais 1, Soraya Seedat 1, Charles D. H. Parry 1,5 and Philip A. May 2,3.
1 Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
2 Center on Alcoholism, Substance Abuse, and Additions (CASAA), The University of New Mexico, Albuquerque, NM 87106, USA
3 Gillings School of Global Public Health, Department of Nutrition, Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
4 School of Social Work, Howard University, Washington, DC 20059, USA
5 Tobacco & Other Drug Research Unit, Medical Research Council of South Africa, Alcohol, Tygerberg 7505, South Africa
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.