CRAFFT Screening Test

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The CRAFFT Screening Test[1] is a short clinical assessment tool designed to screen for substance-related risks and problems in adolescents. CRAFFT stands for the key words of the 6 items in the second section of the assessment - Car, Relax, Alone, Forget, Friends, Trouble. The questionnaire contains 9 items in total, answered in a "yes" or "no" format. The first three items (Part A) evaluate alcohol and drug use over the past year and the other six (Part B) ask about situations in which the respondent used drugs or alcohol and any consequences of the usage. The CRAFFT can function as a self-report questionnaire or an interview to be administered by a clinician.[2] Both employ a skip pattern: those whose Part A score is "0" (no use) answer the Car question only of Part B, while those who report any use in Part A also answer Part B's five CRAFFT questions. Each "yes" answer is scored as "1" point and a CRAFFT total score of two or higher identifies "high risk" for a substance use disorder and warrants further assessment.

Development and history

The CRAFFT Screening Test was developed by John R Knight, MD and colleagues at the Center for Adolescent Substance Abuse Research (CeASAR) at Boston Children's Hospital.[3] Their goal was to develop a screening tool that - like the CAGE questionnaire used for adults - was brief and easy to administer and score.[4] Unlike the CAGE, the CRAFFT was designed to be developmentally appropriate for adolescents and screen conjointly for both alcohol and drug use. Because alcohol- and drug-related motor-vehicle crashes are the leading cause of death among adolescents, the CRAFFT includes a single risk item to evaluate this. It has been established as valid and reliable for identifying youth who need further assessment and therapeutic intervention [5] The CRAFFT was originally designed to screen adolescents at high risk of substance use disorders in primary medical care offices. However, the necessity for an adolescent screening measure was made apparent by research findings suggesting that half of high school students drink, a third binge drink, and a fourth use marijuana.[6] For drug use specifically, studies show that more than half of high school seniors have used an illegal drug of any kind and a fourth have used illegal drugs other than marijuana.[7][8] In addition, more than two-thirds of high school seniors, half of sophomores, and a third of eighth graders have used alcohol in the past year.[8] These findings also contributed to the identification of a need for a tool like the CRAFFT to be developed.

Psychometrics

Research has shown that CRAFFT has relatively high sensitivity and specificity, internal consistency, and test-retest reliability as a screener for alcohol and substance misuse.[9] The CRAFFT questionnaire has been validated against the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and demonstrates good ability to distinguish between those with and without clinical levels of any DSM-5 substance use disorder.[10] It is supported by many studies as a reliable and valid assessment of substance abuse in adolescents[11][12][13] and is considered an effective tool for assessing whether further assessment is warranted.[4][11][14] It has been well-validated against criterion standard psychological tests and structured psychiatric diagnostic interviews.[15][16][17] It has been recommended by the American Academy of Pediatrics' Committee on Substance Abuse for use with adolescents.[14] Findings suggest that pediatricians should regularly screen for substance abuse in adolescents using the CRAFFT.[18]

The CRAFFT has been translated into many languages, including Mandarin, French, Haitian Creole, French, Hebrew, Japanese, Khmer, Laotian, Russian, Portuguese, Spanish, Turkish, and Vietnamese.[14] Studies attest to its validity and reliability across cultures.[19][20][21][22][23]

Items

The questionnaire consists of two parts. Part A asks about alcohol and drug use over the past year, and Part B asks about situations in which the respondent used drugs or alcohol and possible consequences resulting from said use. Scores of 2 or higher indicate high risk, and distinguish between problem (problem use, abuse, dependence) usage versus no use or occasional use.[11]

Part A asks whether during the past 12 months the respondent:

  1. Drank any alcohol (more than a few sips)
  2. Smoked any marijuana or hashish
  3. Used anything else to get "high".

If the respondent answers "no" to all three questions in Part A, they need only answer the first question of Part B. If he/she answers "yes" to any of the above three questions, the respondent must answer all six questions in Part B.

Part B, which is the source of the CRAFFT acronym, asks the respondent:

  1. Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or other drugs?
  2. Do you ever use alcohol or other drugs to RELAX, feel better about yourself, or fit in?
  3. Do you ever use alcohol or other drugs while you are ALONE?
  4. Do you ever FORGET things you did while using alcohol or other drugs?
  5. Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
  6. Have you ever gotten into TROUBLE while you were using alcohol or other drugs?

See also

References

  1. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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  6. ↑ Centers for Disease Control and Prevention, Youth risk behavior surveillance—United States, 1999" MMWR Morb Mortal Wkly Rep 2000;49 ((SS-5)) 1- 96
  7. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  8. ↑ 8.0 8.1 Lua error in package.lua at line 80: module 'strict' not found.
  9. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  10. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  11. ↑ 11.0 11.1 11.2 Lua error in package.lua at line 80: module 'strict' not found.
  12. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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  14. ↑ 14.0 14.1 14.2 14.3 Lua error in package.lua at line 80: module 'strict' not found.
  15. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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  22. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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