CRAFFT Screening Test

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. ↑ "CRAFFT Screen", CeASAR (The Center for Adolescent Substance Abuse Research), retrieved 31 August 2015
  2. ↑ "CRAFFT (Screen for substance abuse)". Health and Human Services Departments & Divisions. Commonwealth of Massachusetts.
  3. ↑ Knight, J. R.; Shrier, L. A.; Bravender, T. D.; Farrell, M.; Vander Bilt, J.; Shaffer, H. J. (1999-06-01). "A new brief screen for adolescent substance abuse". Archives of Pediatrics & Adolescent Medicine 153 (6): 591–596. doi:10.1001/archpedi.153.6.591. ISSN 1072-4710. PMID 10357299.
  4. 1 2 Neinstein, Lawrence S; Gordon, Catherine M; Katzman, Debra K; Rosen, David S; Woods, Elizabeth R, eds. (2008), "CRAFFT", Adolescent Health Care: A Practical Guide, Issue 414 (5th ed.), Wolters Kluwer / Lippincott Williams & Wilkins, p. 950, ISBN 978-0-7817-9256-1, retrieved 21 November 2010
  5. ↑ Kann, Laura; Kinchen, Steve; Shanklin, Shari L.; Flint, Katherine H.; Kawkins, Joseph; Harris, William A.; Lowry, Richard; Olsen, Emily O'Malley; McManus, Tim (2014-06-13). "Youth risk behavior surveillance--United States, 2013". Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002). 63 Suppl 4: 1–168. ISSN 1545-8636. PMID 24918634.
  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. ↑ Johnston, LD; O'Malley, PM; Bachman, JG (2001), Monitoring the Future national survey results on drug use, 1975-2000. Volume I: Secondary school students (NIH Publication No. 01-4924) (PDF), retrieved 28 September 2015
  8. 1 2 "Demographic Subgroup Trends Among Adolescents for Fifty-One Classes of Licit and Illicit Drugs" (PDF). Monitoring the future: Occasional paper series. Retrieved 28 September 2015.
  9. ↑ Dhalla, S; Zumbo, BD; Poole, G (March 2011), "A review of the psychometric properties of the CRAFFT instrument: 1999-2010.", Current drug abuse reviews 4 (1): 57–64, doi:10.2174/1874473711104010057, PMID 21466499
  10. ↑ Mitchell, SG; Kelly, SM; Gryczynski, J; Myers, CP; O'Grady, KE; Kirk, AS; Schwartz, RP (2014), "The CRAFFT cut-points and DSM-5 criteria for alcohol and other drugs: a reevaluation and reexamination.", Substance abuse 35 (4): 376–80, doi:10.1080/08897077.2014.936992, PMID 25036144
  11. 1 2 3 Knight, John R; Sherritt, Lon; Harris, Sion Kim; Chang, Grace (June 2002), "Validity of the CRAFFT Substance Abuse Screening Test Among Adolescent Clinic Patients" (PDF), Archives of Pediatrics & Adolescent Medicine 156: 607–614, doi:10.1001/archpedi.156.6.607, PMID 12038895, retrieved 21 November 2010
  12. ↑ Knight, JR; Sherritt, L; Harris, SK; Gates, EC; Chang, G (January 2003), "Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT.", Alcoholism: Clinical and Experimental Research 27 (1): 67–73, doi:10.1111/j.1530-0277.2003.tb02723.x, PMID 12544008
  13. ↑ Dhalla, Shayesta; Zumbo, Bruno D.; Poole, Gary (2011-03-01). "A review of the psychometric properties of the CRAFFT instrument: 1999-2010". Current Drug Abuse Reviews 4 (1): 57–64. doi:10.2174/1874473711104010057. ISSN 1874-4745. PMID 21466499.
  14. 1 2 3 4 "The CRAFFT Screening Tool", The Center for Adolescent Substance Abuse Research (CeASAR) (Children's Hospital Boston), 2009, retrieved 21 November 2010
  15. ↑ Knight, J. R.; Shrier, L. A.; Bravender, T. D.; Farrell, M.; Vander Bilt, J.; Shaffer, H. J. (1999-06-01). "A new brief screen for adolescent substance abuse". Archives of Pediatrics & Adolescent Medicine 153 (6): 591–596. doi:10.1001/archpedi.153.6.591. ISSN 1072-4710. PMID 10357299.
  16. ↑ Knight, John R.; Sherritt, Lon; Shrier, Lydia A.; Harris, Sion Kim; Chang, Grace (2002-06-01). "Validity of the CRAFFT substance abuse screening test among adolescent clinic patients". Archives of Pediatrics & Adolescent Medicine 156 (6): 607–614. doi:10.1001/archpedi.156.6.607. ISSN 1072-4710. PMID 12038895.
  17. ↑ Dhalla, Shayesta; Zumbo, Bruno D.; Poole, Gary (2011-03-01). "A review of the psychometric properties of the CRAFFT instrument: 1999-2010". Current Drug Abuse Reviews 4 (1): 57–64. doi:10.2174/1874473711104010057. ISSN 1874-4745. PMID 21466499.
  18. ↑ Levy, SJ; Kokotailo, PK (November 2011). "Substance use screening, brief intervention, and referral to treatment for pediatricians.". Pediatrics 128 (5): e1330–40. doi:10.1542/peds.2011-1754. PMID 22042818.
  19. ↑ Kandemir, H; Aydemir, Ö; Ekinci, S; Selek, S; Kandemir, SB; Bayazit, H (2015). "Validity and reliability of the Turkish version of CRAFFT Substance Abuse Screening Test among adolescents.". Neuropsychiatric disease and treatment 11: 1505–9. doi:10.2147/NDT.S82232. PMID 26150721.
  20. ↑ Subramaniam, M; Cheok, C; Verma, S; Wong, J; Chong, SA (December 2010). "Validity of a brief screening instrument-CRAFFT in a multiethnic Asian population.". Addictive behaviors 35 (12): 1102–4. doi:10.1016/j.addbeh.2010.08.004. PMID 20805016.
  21. ↑ Bertini, MC; Busaniche, J; Baquero, F; Eymann, A; Krauss, M; Paz, M; Catsicaris, C (April 2015). "Transcultural adaptation and validation of the CRAFFT as a screening test for problematic alcohol and substance use, abuse and dependence in a group of Argentine adolescents.". Archivos argentinos de pediatria 113 (2): 114–8. doi:10.5546/aap.2015.eng.114. PMID 25727823.
  22. ↑ Cummins, LH; Chan, KK; Burns, KM; Blume, AW; Larimer, M; Marlatt, GA (September 2003). "Validity of the CRAFFT in American-Indian and Alaska-Native adolescents: screening for drug and alcohol risk.". Journal of studies on alcohol 64 (5): 727–32. doi:10.15288/jsa.2003.64.727. PMID 14572196.
  23. ↑ Cote-Menendez, M; Uribe-Isaza, MM; Prieto-Suárez, E (2013). "[Validation for Colombia of the CRAFFT substance abuse screening test in adolescents].". Revista de salud publica (Bogota, Colombia) 15 (2): 220–32. PMID 24892665.
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