CRAFFT: Adolescent Substance Use Screening Tool
6-item AAP-recommended screener for adolescent alcohol and drug use (ages 12–21). Score ≥2 is a positive screen for high-risk substance use or a substance use disorder.
CRAFFT Score Interpreter
Indicates high-risk use. A brief motivational intervention and referral for a full substance use assessment are recommended.
6 yes/no items; each 'Yes' = 1 point. Total range 0–6. Higher scores indicate greater substance use risk.
| Total score (Part B) | Interpretation |
|---|---|
| 4+ | High RiskHigh probability of a substance use disorder. Refer for a comprehensive substance use evaluation and consideration of treatment. |
| 2–3 | Positive ScreenIndicates high-risk use. A brief motivational intervention and referral for a full substance use assessment are recommended. |
| 0–1 | Negative ScreenLow-risk result. Brief positive feedback and anticipatory guidance about substance use are still recommended as part of preventive care. |
Knight JR et al. (2002); Mitchell SG et al. (2014). ≥2 cutoff validated against DSM criteria. Score gradations above ≥2 reflect clinical convention rather than a separately validated threshold. Educational reference only — not a diagnostic tool.
Foundational Context
The CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) was developed by John R. Knight and colleagues at the Center for Adolescent Substance Abuse Research (CeASAR) at Boston Children's Hospital (2002). It is the most validated and widely recommended substance use screening tool for adolescents aged 12–21, endorsed by SAMHSA, the American Academy of Pediatrics (AAP), and NIDA.
The American Academy of Pediatrics (AAP) recommends annual substance use screening for all adolescents as part of preventive health visits. The most current version, CRAFFT 2.1, addresses evolving patterns including electronic cigarettes and prescription drug misuse.
What the Assessment Measures
The CRAFFT v2.1 assesses alcohol and drug use risk in adolescents across two stages:
Part A (initial screen): Three questions about alcohol, marijuana, and other substance use in the past 12 months.
- If the patient answers "No" to all three, only the "Car" question is required.
- If any Part A answer is "Yes," all six CRAFFT questions are administered.
Part B (CRAFFT acronym items):
- C, Car: Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?
- R, Relax: Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
- A, Alone: Do you ever use alcohol or drugs while you are by yourself, ALONE?
- F, Forget: Do you ever FORGET things you did while using alcohol or drugs?
- F, Friends: Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
- T, Trouble: Have you ever gotten into TROUBLE while you were using alcohol or drugs?
Each item is scored Yes (1) or No (0). Total score: 0–6.
Interpretation Guidelines
Score ranges:
- 0–1: Negative Screen. Low risk; brief positive feedback and anticipatory guidance recommended.
- 2–3: Positive Screen. High-risk use; brief motivational intervention and consider referral to substance use assessment.
- 4–6: High Risk. High probability of a substance use disorder; refer to detailed substance use evaluation and treatment.
Clinical threshold:
- ≥2 is the validated cutoff for identifying adolescents who may benefit from a full assessment or intervention. At this threshold, sensitivity is ~76% and specificity is ~94% for DSM-defined alcohol use disorder.
Administration Considerations
- Part A: Ask about past-12-month use of alcohol, marijuana, and other substances.
- Part B: Administer the 6 CRAFFT questions. If Part A was negative, only the "Car" question is strictly required, though completing all 6 provides a full score.
- Scoring: Sum all "Yes" responses from Part B.
- Action: Deliver brief counselling based on the score range.
Psychometric Properties
- Reliability: Good internal consistency (α = 0.68–0.80).
- Validity: Sensitivity ~76%, specificity ~94% for DSM alcohol use disorder at cutoff ≥2.
- Populations: Validated for ages 12–21 in primary care, emergency departments, and school health settings.
Limitations
- Does not differentiate by substance type in the final score.
- Self-report is subject to social desirability effects; confidentiality is critical.
- Not designed for youth under age 12.
References
Knight, J. R., Sherritt, L., Shrier, L. A., Harris, S. K., & Chang, G. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of Pediatrics & Adolescent Medicine, 156(6), 607-614.
Frequently Asked Questions
What does a CRAFFT score of 2 or higher mean?
A score of 2 or higher is the validated positive screen threshold, indicating a significant risk of a substance use disorder or high-risk substance use. At this cutoff, the tool demonstrates sensitivity of approximately 76% and specificity of approximately 94% for DSM-defined alcohol use disorder. A positive screen should prompt a more thorough clinical assessment, not a diagnosis.
Is the CRAFFT self-report or clinician-administered?
The CRAFFT can be self-administered or administered verbally by a clinician. Both formats are widely used in primary care and school health settings. Confidentiality should be clearly communicated to the adolescent regardless of format, as it substantially improves honest disclosure.
Can the CRAFFT diagnose a substance use disorder?
No. The CRAFFT is a brief screening tool, not a diagnostic instrument. A positive screen (score ≥2) identifies adolescents who are likely to benefit from a comprehensive clinical evaluation. A formal substance use disorder diagnosis requires a structured clinical interview using established criteria such as DSM-5.
What age range is the CRAFFT designed for?
The CRAFFT is validated for adolescents aged 12–21. It is not intended for use in children under 12. The American Academy of Pediatrics recommends its use as part of annual preventive health visits throughout adolescence.
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