Steps to using CRAFFT are outlined below:
Begin by asking the opening questions regarding the frequency of the patient’s substance use during the past 12 months.
Ask the CRAFFT questions.
If the patient answered “0” to all the opening “frequency of use” questions, ask the CAR question only. If the patient provided an answer >”0” to any of the “frequency of use” questions, ask the full set of six CRAFFT questions.
Communication of risk – DSM-5 Criteria for a Substance Use Disorder
The first step is to tell adolescents their CRAFFT “score” and to show where that score falls on the bar chart at the top of 2nd side of the CRAFFT card or Clinician-administered CRAFFT Interview. This chart shows data from a recent study testing the CRAFFT screener’s validity in identifying adolescents meeting DSM-5 criteria for a SUD (Mitchell et al., 2014). The bar chart shows the percentage of adolescents meeting criteria for a DSM-5 SUD by CRAFFT score. Using these percentages on the bar chart, the clinician should discuss with the adolescent their likelihood of having a potential problem with substance use based on their CRAFFT score.
Revised clinician Talking Points – the “5 Rs” of brief counseling
The next step is to have a brief motivational enhancement discussion with the adolescent using the recommended Talking Points for brief counseling. These talking points incorporate the latest science on the developing brain and substance use harms, and promote the use of strategies informed by Motivational Enhancement Therapy (MET).
From this foundation we developed the “5 Rs” of brief counseling:
- REVIEW screening results
- RECOMMEND not to use
- RIDING/DRIVING risk counseling
- RESPONSE: elicit self-motivational statements
- REINFORCE self-efficacy
Examples are provided at each step to guide clinicians through the conversation with their patients.
Provide each patient with the Contract for Life.
What is the CRAFFT 2.1?
This revised version of the CRAFFT screening tool incorporates changes that enhance the sensitivity of this well-validated and widely-utilized adolescent substance use screening tool to accurately identify adolescents at risk for a substance use disorder. It also presents new recommended clinician talking points, informed by the latest science and clinician feedback, to guide a brief discussion about substance use with adolescents and includes vaping as a method of administration for marijuana.
For more detailed information on the CRAFFT 2.1, please click here to see the provider manual.
How should I use the CRAFFT Screening Tool in my practice?
- The CRAFFT Screening Tool was designed for use by trained healthcare professionals in a confidential healthcare setting.
- The Massachusetts Department of Public Health Bureau of Substance Abuse Services has created the Adolescent SBIRT Toolkit for Providers [pdf] which is available for qualified clinicians. http://massclearinghouse.ehs.state.ma.us/BSASSBIRTPROG/SA1099.html
What is the appropriate patient age range for use of the CRAFFT screening tool?
The CRAFFT Screening tool has been validated for 12-18 year old youths by researchers at the Center for Adolescent Substance Abuse Research, Boston Children’s Hospital. However, other established researchers have validated the CRAFFT for use up to the age of 26 years old. Please visit the CRAFFT Publications page to download PDF’s of our center’s research validating the CRAFFT screening tool.
What are the advantages of using the CRAFFT Clinician Interview vs. the CRAFFT Self-administered Questionnaire?
CeASAR recommends that you use the CRAFFT Self-administered Questionnaire in your practice. Our research has found that youth prefer to take this self-administered version before seeing their healthcare professional and are more likely to answer the questions honestly.
How is the CRAFFT Screening Tool confidentiality protected?
In the United States, the federal Confidentiality of Alcohol and Drug Abuse Patient Records rules [42CFR Part 2] protects the use and disclosure of medical records pertaining to alcohol and drug abuse prevention which includes the CRAFFT Screening Tool. The records may be shared in certain circumstances including when: 1) state law requires parental consent to treatment and 2) the minor applicant for services lacks capacity for rational choice as required by [42 CRF Part 2 subpart B, §2.14]. Please review your state laws regarding minor patients.
For more information on Substance Abuse Confidentiality Regulations please visit:
- The U.S. Government Publishing Office
- SAMHSA: Substance Use Confidentiality Regulations: http://www.samhsa.gov/about-us/who-we-are/laws/confidentiality-regulations-faqs
- SAMHSA: Changes in 42 CFR Part 2 guidance related to COVID-19: https://www.samhsa.gov/sites/default/files/covid-19-42-cfr-part-2-guidance-03192020.pdf
As an added safety precaution, we recommend:
- That youth complete the CRAFFT screening tool in a confidential healthcare setting.
- That youth who complete the CRAFFT on paper do not write their names on the paper to protect confidentiality.
Countries outside of the United States also have their own substance abuse confidentiality regulations. Please be advised to review your countries regulations and consult Erin Gibson with any questions or concerns.