Interactive Interpreter

CRAFFT: Adolescent Substance Use Screening Tool

The CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) is a 6-item AAP-recommended screener for alcohol and drug use in adolescents aged 12–21. Score ≥2 is a positive screen for high-risk substance use or a substance use disorder.

For professional reference, research, and education only. Not for diagnosis or medical advice.

CRAFFT Score Interpreter

  • Enter a total score to see its range.

  • 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.
    2–3Positive ScreenIndicates high-risk use. A brief motivational intervention and referral for a full substance use assessment are recommended.
    0–1Negative 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.

The CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) is a 6-item yes/no screening questionnaire for alcohol and other drug use in adolescents. It was first published in 1999 by John R. Knight and colleagues at Boston Children's Hospital [4], validated in a general adolescent clinic in 2002 [1], and has been described as the most widely used screen for adolescent alcohol and other substance misuse [2].

What does the CRAFFT measure?

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.

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 adolescent 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?

How do you give the CRAFFT?

  1. Part A: Ask about past-12-month use of alcohol, marijuana, and other substances.
  2. 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.
  3. Scoring: Sum all "Yes" responses from Part B.
  4. Action: Deliver brief counselling based on the score range; a brief motivational interviewing conversation suits a positive screen.

The CRAFFT can be self-administered or administered verbally by a clinician. Confidentiality should be clearly communicated to the adolescent regardless of format.

How do you score and interpret the CRAFFT?

Each item is scored Yes (1) or No (0). Total score: 0–6.

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 [1] [2].
  • The 4–6 band reflects clinical convention rather than a separately validated threshold.

Psychometric properties

  • Development: In 99 adolescents aged 14–18 known to use alcohol or drugs, the 9 candidate items had good internal consistency (Cronbach's α 0.79), and the 6 items kept for the CRAFFT correlated highly with the criterion measure (r = 0.84) [4].
  • Validity: In 538 adolescents aged 14–18 at a hospital-based clinic, CRAFFT scores correlated strongly with diagnostic classification (Spearman rho 0.72). At a cutoff of ≥2, sensitivity was 0.76 and specificity 0.94 for any problem (problem use, abuse or dependence), 0.80 and 0.86 for any disorder, and 0.92 and 0.80 for dependence. Validity was not significantly affected by age, sex, or race [1].
  • DSM-5: In 525 adolescents aged 12–17 attending primary care, the AUC was 0.93 for problem use and 0.97 for DSM-5 substance use disorder, and the cut-point of 2 remained optimal [2].
  • Heavy cannabis use: In a statewide sample of 132,555 adolescents, a cutoff of 2 gave sensitivity of 82.0% and specificity of 83.7% for heavy cannabis use [3].

Limitations

  • Screening, not diagnosis: a positive screen calls for a comprehensive clinical evaluation.
  • For adults, use a measure built for them, such as the CAGE-AID or DAST-10.
  • 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.

For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.

Related

FAQ

  • 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 original validation study found sensitivity of 76% and specificity of 94% for any substance-related problem (problem use, abuse or dependence), and sensitivity of 80% and specificity of 86% for any substance 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 tool. 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.

References

    1. 1.Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med. 2002;156(6):607-614.
    2. 2.Mitchell SG, Kelly SM, Gryczynski J, Myers CP, O'Grady KE, Kirk AS, Schwartz RP. The CRAFFT cut-points and DSM-5 criteria for alcohol and other drugs: a reevaluation and reexamination. Subst Abus. 2014;35(4):376-380.
    3. 3.Lee CA, Smith DC, Lanker A, Clary KL. Sensitivity and specificity of the CRAFFT to identify heavy cannabis use: Evidence from a large statewide adolescent sample. Addict Behav. 2021;122:107006.
    4. 4.Knight JR, Shrier LA, Bravender TD, Farrell M, Vander Bilt J, Shaffer HJ. A new brief screen for adolescent substance abuse. Arch Pediatr Adolesc Med. 1999;153(6):591-596.

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