- CRAFFT is the most widely recommended substance use screening tool for adolescents aged 12-21
- The acronym stands for Car, Relax, Alone, Forget, Friends, Trouble
- Consists of a brief opening question followed by 6 yes/no questions
- A score of 2 or more positive responses indicates need for further assessment
- Endorsed by the American Academy of Pediatrics for routine adolescent screening
- Validated across diverse populations and available in multiple languages
- Takes approximately 2 minutes to administer
- Screens for both alcohol and drug use in a single instrument
Published: February 2026 | Last Updated: February 2026 | Reading Time: 5 min
What Is the CRAFFT?
The CRAFFT is a behavioral health screening tool designed to assess substance use risk among adolescents and young adults aged 12-21. Developed by Dr. John Knight and colleagues at Boston Children's Hospital, the CRAFFT was first published in 1999 and has since become the most widely recommended and validated substance use screening tool for the adolescent population.
The name CRAFFT is an acronym derived from the key words in its six screening questions, each designed to identify behaviors and consequences associated with risky substance use in young people.
The CRAFFT Questions
The screening begins with an opening Part A question: "During the past 12 months, did you drink any alcohol, use any marijuana, or use anything else to get high?" If the answer is "no," only one additional question is asked. If "yes," all six Part B questions are administered:
C — Car: Have you ever ridden in a CAR driven by someone (including yourself) who was high or had been using alcohol or drugs?
R — Relax: Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
A — Alone: Do you ever use alcohol or drugs while you are by yourself, ALONE?
F — Forget: Do you ever FORGET things you did while using alcohol or drugs?
F — Friends: Do your FRIENDS or family ever tell you that you should cut down on your drinking or drug use?
T — Trouble: Have you ever gotten into TROUBLE while using alcohol or drugs?
Scoring
Each "yes" response scores 1 point, for a maximum of 6. A score of 0-1 indicates lower risk, while a score of 2 or higher suggests a significant problem and the need for a more comprehensive assessment. Research has demonstrated that a score of 2+ has sensitivity of approximately 76% and specificity of 94% for identifying a substance use disorder in adolescents.
Why Adolescent-Specific Screening Matters
Developmental Vulnerability
The adolescent brain is uniquely vulnerable to the effects of substance use. The prefrontal cortex — responsible for judgment, impulse control, and decision-making — does not fully mature until the mid-20s. Early substance use during this critical developmental window can cause lasting changes in brain structure and function, increasing the risk of addiction and cognitive impairment.
The Screening Gap
Despite the importance of early identification, many adolescents are not routinely screened for substance use during healthcare visits. The American Academy of Pediatrics recommends universal substance use screening at every well-visit beginning at age 12, making the CRAFFT's brevity and ease of use particularly valuable.
Clinical Application
In Pediatric and Primary Care
The CRAFFT fits seamlessly into routine adolescent well-visits. It can be administered verbally, as a written questionnaire, or via electronic health record integration. Providers use results to guide conversations, provide brief interventions, and determine whether referral to specialized services is warranted.
Confidentiality Considerations
Adolescent substance use screening raises important confidentiality considerations. Most states provide minors some degree of confidentiality for substance use treatment, and providers should explain confidentiality protections before administering the screen to encourage honest responses.
Frequently Asked Questions
Can the CRAFFT be used for adults?
The CRAFFT was designed and validated for ages 12-21. For adults over 21, tools like the AUDIT (alcohol), DAST (drugs), or ASSIST (all substances) are more appropriate.
Is the CRAFFT available in other languages?
Yes. The CRAFFT has been translated into over 15 languages and validated in multiple international settings, making it accessible to diverse populations.
What happens after a positive CRAFFT screen?
A positive screen (score of 2+) triggers a more detailed clinical assessment. This may include a comprehensive substance use evaluation, motivational interviewing, and if warranted, referral to an adolescent substance abuse treatment program. The goal is early intervention before patterns become entrenched.
References
- Knight, J.R., et al. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of Pediatrics & Adolescent Medicine.
- American Academy of Pediatrics. (2016). Substance Use Screening, Brief Intervention, and Referral to Treatment.
- Levy, S.J. & Williams, J.F. (2016). Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics.
- Mitchell, S.G., et al. (2014). CRAFFT screening for substance use in adolescents. Journal of Adolescent Health.
- Knight, J.R., et al. (1999). A new brief screen for adolescent substance abuse. Archives of Pediatrics & Adolescent Medicine.
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