What is CRAFFT?
CRAFFT is a validated 6-question screening tool specifically designed to identify risky substance use behaviors in adolescents aged 12-21 years, screening for both alcohol and drug use in less than 2 minutes. 1
Structure and Administration
The CRAFFT acronym represents six yes/no questions, with each "yes" response scoring 1 point 1:
- C (Car): Have you ever ridden in a car driven by someone (including yourself) who was "high" or had been using drugs or alcohol? 1
- R (Relax): Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in? 1
- A (Alone): Do you ever use alcohol or drugs while you are by yourself, alone? 1
- F (Forget): Do you ever forget things that you did while using alcohol or drugs? 1
- F (Friends): Does your family or friends ever tell you that you should cut down on your drinking or drug use? 1
- T (Trouble): Have you ever gotten into trouble while you were using alcohol or drugs? 1
Scoring and Interpretation
A score of 2 or higher is generally considered a positive screening result, indicating the need for further assessment or brief intervention. 1
Key Performance Characteristics
- Administration time: Less than 2 minutes 1
- Delivery formats: Can be administered as an interview, paper-based self-report, or computer-based self-report 1
- Sensitivity and specificity: High across a range of populations and settings 1
- Gender bias: Shows no evidence of gender bias between male and female adolescents 1
Clinical Applications and Endorsements
The CRAFFT is recommended by both the American Academy of Pediatrics (AAP) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) for screening adolescents in primary care and pediatric settings. 1
The tool has been validated across multiple clinical contexts 1:
- Pediatric primary care offices 1
- School-based health centers 2
- Emergency departments and acute care settings 1
Extended Use Beyond Adolescents
While designed for adolescents, the CRAFFT has shown preliminary utility in young pregnant women 1:
- In a small pilot study (n=30) of pregnant adolescents and young women ages 17-25, CRAFFT demonstrated a positive predictive value of 90% and negative predictive value of 80% when compared to calendar-based recall 1
- When compared to diagnostic interview standards, it showed a positive predictive value of 58% and negative predictive value of 83% 1
Important Implementation Considerations
Confidentiality is essential for accurate screening responses—adolescents should be interviewed alone, with parents/guardians excused from the room during this portion of the visit. 1
Federal and state privacy laws support adolescent confidentiality regarding substance use screening, with the exception of immediate risk of harm to self or others 1
Common Pitfall to Avoid
Do not confuse CRAFFT with other adolescent screening tools like S2BI (Screening to Brief Intervention), AUDIT-C, or BSTAD—while these are also validated for adolescent substance use screening, CRAFFT is the most extensively studied tool specifically designed for medical settings and has the strongest evidence base for use in primary care. 1, 3