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A New Brief Screen for Adolescent Substance Abuse
John R. Knight, MD;
Lydia A. Shrier, MD, MPH;
Terrill D. Bravender, MD;
Michelle Farrell;
Joni Vander Bilt, MPH;
Howard J. Shaffer, PhD
Arch Pediatr Adolesc Med. 1999;153:591-596.
Objective To develop a brief alcohol and other drug (AOD) screening test for adolescents.
Methods A 9-item test was constructed by combining and modifying items from several AOD assessments, and administered concurrently with the Personal Involvement With Chemicals Scale (PICS), the criterion standard.
Setting A hospital-based adolescent clinic.
Subjects Fourteen- to 18-year-old patients consecutively arriving for routine medical care who were known to have used AOD.
Measures Internal consistency of the 9 items was calculated using the Cronbach  . The relationship between the brief screen and PICS raw score was determined by stepwise linear regression analysis. The PICS T score has been shown to correctly classify substance abuse treatment need as no treatment (T<35), brief office intervention (T=35-40), outpatient or short-term treatment (T=41-54), and inpatient or long-term treatment (T 55). Sensitivity and specificity rates for predicting a PICS T score of 55 or higher were calculated from 2 x 2 tables.
Results Ninety-nine adolescents were tested (70.7% female, 36.4% black, 32.3% white, 19.2% Hispanic, mean age, 16.3 years). The 9 items had good internal consistency (Cronbach =.79). Stepwise linear regression analysis identified 6 items whose total combined score was highly correlated with PICS (Pearson r=0.84, P<.01). This model correctly classified 86% of subjects according to the PICS criteria. Two or more yes answers had a sensitivity of 92.3% and specificity of 82.1% for intensive AOD treatment need. The 6 items were arranged into a mnemonic (CRAFFT).
Conclusions Further research must confirm the test's psychometric properties in a general clinic population. However, CRAFFT seems promising as a brief AOD screening test.
From the Divisions of General Pediatrics (Dr Knight) and Adolescent and Young Adult Medicine (Drs Shrier and Bravender), Children's Hospital, and Division on Addictions, Harvard Medical School (Drs Knight and Shaffer and Ms Vander Bilt), Boston, Mass; and Colby College and Harvard BASE Project, Waterville, Me (Ms Farrell).
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