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CRAFFT Screening Test

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The CRAFFT [1] is a brief 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. As of 2020, updated versions of the CRAFFT known as the “CRAFFT 2.1” and "CRAFFT 2.1+N" have been released.

The older version of 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 2.1 screening tool begins with past-12-month frequency items (Part A), rather than the previous “yes/no” question for any 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 usage.

The CRAFFT can function as a self-report questionnaire or an interview to be verbally 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 was developed by John R. Knight, MD and colleagues at the Center for Adolescent Behavioral Health Research (CABHRe), formerly known as 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 other drug use. Because substance-related motor-vehicle crashes are the leading cause of death among adolescents, the CRAFFT includes a single risk item to evaluate riding risk. The CRAFFT has been established as valid and reliable for identifying youth who need further assessment and therapeutic intervention for their substance use. [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 a universal 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]

CRAFFT 2.1

This revised version of the CRAFFT screening tool incorporates changes that enhance the sensitivity of the system in terms of identifying adolescents with substance use, and presents new recommended clinician talking points, informed by the latest science and clinician feedback, to guide a brief discussion about substance use with adolescents. The CRAFFT 2.1 provides an updated and revised version of this well-validated and widely utilized adolescent substance use screening protocol.[citation needed]

The CRAFFT 2.1 screen begins with open answer frequency items for the past 12 months, rather than the previous “yes/no” questions for use over the past year. A recent study examining these opening yes/no questions found that they had relatively low sensitivity in identifying youth with any past-12-month alcohol or marijuana use (62% and 72%, respectively).[1] Research also has suggested that yes/no questions may contribute to lower sensitivity on certain measures by inhibiting disclosure of less socially desirable behaviors; i.e., they may be more prone to social desirability bias.[2] The instruction, “Say ‘0’ if none” was also added to each of the initial questions so that use is not conveyed as expected behavior.

These open answer frequency question had improved sensitivity of 79% and specificity of 86% for detecting past-12-month use of any substance, compared to that of the “yes/no” questions found in the prior study.[1][3]

The CRAFFT 2.1 is available in the following languages: Albanian, Arabic, Burmese, Chinese - Simplified, Chinese - Traditional, Cape Verdean Creole, Haitian Creole, Dutch, English, French, German, Greek, Hindi, Japanese, Khmer, Korean, Laotian, Lithuanian, Nepali, Portuguese (Brazil), Portuguese (Portugal), Romanian, Russian, Somali, Spanish (Lat Am), Spanish (Spain), Swahili, Telugu, Turkish, Twi, and Vietnamese.[7]

CRAFFT 2.1+N (Nicotine)

This version of the CRAFFT includes a frequency question to screen for tobacco/nicotine use as part of the opening questions. If a patient reports any days of tobacco or nicotine use, they are administered the Hooked on Nicotine Checklist (in addition to any CRAFFT questions any other reported alcohol or drug use requires), which screens for tobacco/nicotine dependence.[8] Any positive response on this 10-item instrument indicates a serious problem with nicotine that requires further assessment.

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.[4] 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.[5] It is supported by many studies as a reliable and valid assessment of problematic substance use in adolescents[6][9][10] and is considered an effective tool for assessing whether further assessment is warranted.[6][11][12] It has been well-validated against criterion standard psychological tests and structured psychiatric diagnostic interviews.[13][14][15] It has been recommended by the American Academy of Pediatrics' Committee on Substance Abuse for use with adolescents.[12] Findings suggest that pediatricians should regularly screen for substance abuse in adolescents using the CRAFFT.[16]

The CRAFFT 2.1+N is available in the following languages: Albanian, Arabic, Burmese, Chinese - Simplified, Chinese - Traditional, Cape Verdean Creole, Haitian Creole, Dutch, English, French, German, Greek, Hindi, Japanese, Khmer, Korean, Laotian, Lithuanian, Nepali, Portuguese (Brazil), Portuguese (Portugal), Romanian, Russian, Somali, Spanish (Lat Am), Spanish (Spain), Swahili, Telugu, Turkish, Twi, and Vietnamese.[7] Studies attest to its validity and reliability across cultures.[17][18][19][20][21][excessive citations]

See also

References

  1. ^ a b c Harris, Sion K; et al. (2015). "Adolescent substance use screening in primary care: validity of computer self-administered vs. clinician-administered screening". Subst Abus. 1 (37 ed.): 197–203.
  2. ^ a b Couper, M.; et al. (2012). "The design of grids in web surveys". Soc. Sci. Comput. Rev. 3 (31 ed.): 322–345.
  3. ^ a b Harris SK, Sherritt L, Copelas S, Knight JR. Reliability and validity of past-12-month use frequency items as opening questions for the updated CRAFFT adolescent substance use screening system. International Network on Brief Interventions for Alcohol and Drugs Annual Meeting, 2016. Lausanne, Switzerland.
  4. ^ a b 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
  5. ^ a b 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, PMC 4268117, PMID 25036144
  6. ^ a b c Knight, John R; Sherritt, Lon; Harris, Sion Kim; Chang, Grace (June 2002), "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, PMID 12038895
  7. ^ a b "Get the CRAFFT – CRAFFT". Retrieved 2021-10-19.
  8. ^ "Hooked on Nicotine Checklist (HONC) | Division of Cancer Control and Population Sciences (DCCPS)". cancercontrol.cancer.gov. Retrieved 2021-10-19.
  9. ^ 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
  10. ^ 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.
  11. ^ Neinstein, Lawrence S; Gordon, Catherine M; Katzman, Debra K; Rosen, David S; Woods, Elizabeth R, eds. (2008), "CRAFFT", Adolescent Health Care: A Practical Guide, vol. Issue 414 (5th ed.), Wolters Kluwer / Lippincott Williams & Wilkins, p. 950, ISBN 978-0-7817-9256-1, retrieved 21 November 2010 {{citation}}: |volume= has extra text (help)
  12. ^ a b "The CRAFFT Screening Tool", The Center for Adolescent Substance Abuse Research (CeASAR), Children's Hospital Boston, 2009, retrieved 21 November 2010
  13. ^ 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.
  14. ^ 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.
  15. ^ 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.
  16. ^ 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.
  17. ^ 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. PMC 4484694. PMID 26150721.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  18. ^ 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.
  19. ^ 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.
  20. ^ 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.
  21. ^ 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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