CRAFFT: CRAFFT Screening Tool for Adolescent Substance Use

The CRAFFT Screening Tool (version 2.1) is a brief, validated questionnaire designed to screen for substance use risk among adolescents and young adults aged 12-21. Developed by Dr. John R. Knight and colleagues at Boston Children's Hospital, the CRAFFT is the most widely recommended substance use screening instrument for this age group.

Why the CRAFFT matters: Adolescent substance use is a significant public health concern. Early identification enables timely intervention before patterns become entrenched. The CRAFFT provides a quick, evidence-based way to identify young people who may benefit from further evaluation or brief counseling about substance use risks.

The name CRAFFT is a mnemonic for the six key risk-related questions in Part B:

• C — Car: Riding with an impaired driver (or driving while impaired)
• R — Relax: Using substances to relax or feel better
• A — Alone: Using substances alone
• F — Forget: Forgetting things while using substances
• F — Friends/Family: Others expressing concern about use
• T — Trouble: Getting into trouble while using substances

Two-part structure: The CRAFFT 2.1 begins with three Part A frequency questions about past-year alcohol, marijuana, and other substance use. If any Part A question is endorsed, all six Part B CRAFFT questions are administered. If all Part A answers are "no," only the Car question (first Part B item) is asked in the standard clinical administration. In this online version, all questions are presented for completeness.

Validation and reliability: The CRAFFT has been validated in multiple studies across diverse adolescent populations. It demonstrates good sensitivity (0.76-0.86) and specificity (0.72-0.94) at a cutoff of 2 or more on Part B. The instrument has been translated into multiple languages and is endorsed by the American Academy of Pediatrics (AAP) for routine adolescent screening.

Clinical applications: The CRAFFT is used in pediatric primary care, school health settings, emergency departments, and behavioral health programs. It serves as a first-step screener — a positive result should lead to further clinical assessment, not a diagnosis.

Important disclaimer: The CRAFFT is a screening tool — it cannot diagnose a substance use disorder. A positive screen indicates the need for further evaluation by a qualified healthcare provider. If you or someone you know needs help with substance use, contact the SAMHSA National Helpline at 1-800-662-4357 (free, confidential, 24/7).

Reference: This assessment is based on the CRAFFT 2.1 from Boston Children's Hospital. The CRAFFT is available for clinical use.

You'll answer 9 questions in two parts. Part A asks about substance use in the past 12 months (3 questions). Part B asks about substance-use-related behaviors and consequences (6 questions). Each answer is Yes (1) or No (0).

Scoring is based on Part B only. The six CRAFFT questions produce a total score from 0 to 6.

Part A — Past 12-Month Use:

• Alcohol use (more than a few sips)
• Marijuana or hashish use
• Other substance use (illegal drugs, prescription misuse, inhalants)

Part B — CRAFFT Questions:

• C (Car) — Riding with an impaired driver
• R (Relax) — Using substances to relax or cope
• A (Alone) — Using substances alone
• F (Forget) — Memory problems related to substance use
• F (Friends/Family) — Others expressing concern
• T (Trouble) — Getting into trouble while using

Most people complete the assessment in 2-3 minutes.

Part B Score Interpretation (0-6):

0 (No Use Reported / Low Risk): If Part A was entirely negative and no Part B items were endorsed, no substance use risk factors were identified. Continue age-appropriate prevention conversations.

1 (Moderate Risk): One CRAFFT risk factor was endorsed. Brief counseling about substance use risks is recommended. Discuss the specific concern and provide education.

2-3 (High Risk — Positive Screen): Score meets the clinical threshold for a positive substance use screen. A brief intervention and further assessment by a healthcare provider are recommended. Contact the SAMHSA National Helpline at 1-800-662-4357 for referral assistance.

4-6 (Severe Risk): Multiple risk factors endorsed, indicating significant substance use concerns. Prompt referral to a substance use specialist is strongly recommended. SAMHSA National Helpline: 1-800-662-4357.

Understanding the cutoff: A Part B score of 2 or higher is considered a positive screen. Research shows this cutoff optimally balances sensitivity and specificity for identifying adolescents with substance use problems that warrant clinical attention.

Part A context: Even if Part B score is 0, a positive Part A (any past-year use reported) should prompt a brief conversation about substance use risks, particularly for younger adolescents.

What a positive screen means: A positive CRAFFT does not mean a substance use disorder diagnosis. It means further clinical evaluation is warranted. A healthcare provider will conduct a more thorough assessment considering frequency, quantity, consequences, and developmental context.

Crisis support: If you or someone you know needs immediate help with substance use, call the SAMHSA National Helpline at 1-800-662-4357 (free, confidential, available 24/7, 365 days a year).