CRAFFT Valid When Screening for Substance Use in Youth

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The CRAFFT screening tool has acceptable concurrent and predictive value for substance use and substance use disorders in youth who visit pediatric emergency departments, and has value in predicting substance use disorders at follow-up.

In those who seek treatment in pediatric emergency departments, the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening tool has acceptable concurrent validity for problematic substance use and substance use disorders (SUDs) and predictive validity for SUDs at up to 3 years of follow-up, but its sensitivity is limited, according to an article published in Pediatrics.  

Between May 2013 and June 2015, young people (ages 12 to 17 years) treated in 16 pediatric emergency departments (n=4753) completed an electronic, self-administered assessment measuring alcohol and drug use and risk behaviors using the CRAFFT screen and Diagnostic Interview Schedule for Children. Investigators re-administered the battery to a subsample (n=2175) after 1, 2, and 3 years to evaluate future SUDs. Of these participants, 46% were white, 26% were African American, and 27% were Hispanic. The mean age was 14.4 years, and 54% were female.

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At baseline, a CRAFFT score of ≥2 was significantly associated with problematic substance use or mild or moderate to severe SUD diagnosis on the Diagnostic Interview Schedule for Children (P <.001). After 1, 2, and 3 years, results were consistent with baseline scores (P <.001). A baseline CRAFFT score of ≥1 as a cutoff for predicting problematic substance use and mild SUD diagnosis at 1, 2, and 3 years exhibited the best combined sensitivity and specificity. The best prediction for a moderate to severe SUD diagnosis at 1 year was a baseline CRAFFT score ≥2, but the cutoff score was ≥1 at 2 and 3 years.

Results were limited to youths treated in pediatric emergency departments and may not be generalizable to other populations. In addition, follow-up rates in the subsample varied from 60% to 71% over 3 years.

“Future studies are needed to determine how the screen can be optimally used in the [pediatric emergency department] as well as how to develop and improve developmentally appropriate interventions in those identified as at risk,” investigators concluded.


Shenoi RP, Linakis JG, Bromberg JR, et al. Predictive validity of the CRAFFT for substance use disorder. Pediatrics. 2019;144(2).