What You Need to Know About the CRAFFT Screening Tool

A short clinical assessment test, the CRAFFT Screening Tool is designed to identify substance-related risks and problems in adolescents under the age of 21. By asking a series of questions, doctors can determine whether or not they have a longer conversation about the context, frequency and other risks or consequences of substance abuse with the teen.

The History of CRAFFT

Composed of nine items in two parts, the CRAFFT Screening Tool was developed by John R. Knight, MD and colleagues at the Center for Adolescent Substance Abuse Research (CeASAR) at Boston Children’s Hospital. The doctors wanted a screening tool for adolescents that would be quick to administer, easy to score and capable of recognizing signs of both drug and alcohol abuse.

The original test was administered in 1999, to 99 adolescents. It was regarded as a promising tool that has since become a common form of medical assessment for physicians.

The CRAFFT Screening Process

When a doctor uses the CRAFFT process, they request that the teen answer all questions honestly and remind the patient that answers are kept confidential. The doctor begins with Part A, which features three opening questions:

  • During the past 12 months, did you drink alcohol (more than a few sips)?
  • During the past 12 months, did you smoke any marijuana or hashish?
  • During the past 12 months, did you use anything else to get high?

If the teen answers “no” to all three opening questions, the doctor will only ask the first question of Part B, while those who respond with a “yes” to any of the opening questions will be asked all six CRAFFT queries.

The six CRAFFT questions:

  • C: Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
  • R: Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
  • A: Do you ever use alcohol/drugs while you are by yourself, or ALONE?
  • F: Do you ever FORGET things you did while using alcohol or drugs?
  • F: Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
  • T: Have you gotten into TROUBLE while you were using alcohol or drugs?

Each affirmative answer to a CRAFFT question is scored as a point, with a CRAFFT total score of two or higher identifying the teen at high risk for a substance abuse disorder. Doctors can further assess the teen and determine the appropriate actions necessary to help the teen with their issue.

The Value of CRAFFT

The American Academy of Pediatrics has recommended the CRAFFT Screening Tool for use among adolescents. The test has been translated into many languages including Turkish, Vietnamese, Haitian Creole, Hebrew and Khmer. Furthermore, studies have shown the technique to be a reliable and valid method of screening for substance misuse.

The main pitfall of the tool is that it relies on honesty. If a teen does not answer the questions truthfully, they may be considered to be at no risk of having a substance abuse problem, even if they actually do use the drug.

A quick and useful method in many respects, the CRAFFT Screening Tool allows doctors to identify a teen who may be misusing substances. Based on that diagnosis, the doctor can determine whether or not further assessment is required. If you think your teen could benefit from the CRAFT questionnaire, talk to your doctor at your teen’s next check-up.

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