BSN Tracker

Assessment Tool: TACE

The TACE questionnaire is a validated four-item alcohol use screen adapted from the CAGE for use in pregnancy and prenatal care settings. It differs from CAGE in that the T item (Tolerance) is weighted: if the patient reports needing 2 or more drinks to feel high, that item scores 2 points. Items A, C, and E score 1 point each for Yes. A total score of ≥ 2 is a positive screen. TACE is used in prenatal health history encounters as part of substance use screening to support fetal alcohol spectrum disorder (FASD) prevention. Pair with motivational interviewing and referral to prenatal substance use services as indicated.

TACE — Alcohol Use Screen (Pregnancy)

A four-item alcohol use screening tool validated for use in pregnancy and adapted from the CAGE questionnaire. Scoring differs from CAGE: the T item (tolerance) scores 2 points if the patient reports needing 2 or more drinks to feel high; each of the remaining items scores 1 point for "Yes." A total score of ≥ 2 is a positive screen. TACE is particularly useful in prenatal settings where accurate alcohol use history is essential for fetal alcohol spectrum disorder prevention.

Score interpretation

0–1

Screen negative

≥ 2

Positive screen — further assessment required

T item is weighted: ≥ 2 drinks needed to feel high = 2 points; 1 drink = 0 points. Items A, C, E score 1 point each for Yes. Maximum score = 5.

T — How many drinks does it Take to make you feel high?

This item is weighted: ≥ 2 drinks = 2 points; 1 drink or none = 0 points.

A — Have people Annoyed you by criticising your drinking?
C — Have you ever felt you ought to Cut down on your drinking?
E — Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye-opener)?

Pregnancy Context

No amount of alcohol has been established as safe during pregnancy. A positive TACE screen warrants compassionate counselling about the risks of fetal alcohol spectrum disorder, referral to obstetric social work or substance use services, and documentation in the prenatal record. Use motivational interviewing principles — avoid shame-based language.