A Score of 2 Means a Positive Screen — Here’s What That Actually Means
Your teen scored 2 on the CRAFFT 2.1 screening tool. That’s the clinical cutoff for a positive screen, meaning their answers suggest a level of substance use risk that warrants attention. Before you panic, let’s talk about what this score actually represents and what it doesn’t.
The CRAFFT was developed specifically for adolescents ages 12–21 and is endorsed by the American Academy of Pediatrics as the gold-standard substance use screening tool for this age group. It’s used in pediatric offices, emergency departments, and school health programs worldwide.
What CRAFFT Stands For
Each letter represents a yes/no question about substance-related behaviors:
C — Car: Have you ever ridden in a car driven by someone (including yourself) who was high or had been using alcohol or drugs? This question assesses risk-taking behavior and exposure to impaired driving — one of the leading causes of death in adolescents.
R — Relax: Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in? Using substances as a coping mechanism or social tool is a different animal than occasional experimentation. It suggests a functional relationship with the substance is developing.
A — Alone: Do you ever use alcohol or drugs while you are by yourself? Solo use removes the social component and suggests the substance itself (not the social experience) is what’s being sought. This is a significant escalation marker.
F — Forget: Do you ever forget things you did while using alcohol or drugs? Blackouts or memory gaps indicate consumption at levels that impair brain function. In teens, this carries additional concern because their brains are still developing.
F — Friends: Do your family or friends ever tell you that you should cut down on your drinking or drug use? External feedback from people who know the teen suggests the behavior is visible and concerning to others.
T — Trouble: Have you ever gotten into trouble while you were using alcohol or drugs? This includes fights, academic problems, legal issues, injuries, or risky sexual behavior. Consequences accumulating despite continued use is a hallmark of developing substance use disorder.
Why a Score of 2 Matters
At the cutoff of 2, the CRAFFT has a sensitivity of about 76% and specificity of about 94% for identifying substance use problems in teens. A score of 2 means your teen’s pattern of answers aligns with adolescents who have clinically relevant substance use — either current problematic use or high risk for developing it.
The specific combination of yes answers matters too. “Car + Trouble” indicates risk-taking with consequences already happening. “Relax + Alone” suggests emotional dependence on substances. Both are concerning but point toward different intervention approaches.
What to Do as a Parent
- Stay calm. Your emotional reaction sets the tone for everything that follows. Panic and anger shut down communication. Take time to process before you confront.
- Have the conversation. Use the results as a starting point, not a weapon. Try: “Your screening suggested some concerns. I want to understand what’s going on so I can help.”
- Schedule a professional follow-up. A pediatrician, adolescent medicine specialist, or therapist who works with teens can conduct a more thorough assessment. The CRAFFT opens the door; a professional walks through it.
- Address the “why.” Teen substance use rarely exists in a vacuum. Anxiety, depression, peer pressure, trauma, academic stress — something is usually driving it. The DASS-21 can help identify whether anxiety or depression might be contributing factors.
- Set clear expectations and consequences. Compassion and boundaries aren’t mutually exclusive. Your teen needs both.
When a Score of 2 Needs Urgent Attention
Most of the time, a CRAFFT of 2 warrants prompt but not emergency action. However, escalate immediately if:
- Your teen is using opioids (fentanyl overdose risk is too high to wait)
- They’re regularly driving under the influence or riding with impaired drivers
- There are signs of withdrawal (shaking, vomiting, severe anxiety)
- Substance use co-occurs with suicidal thoughts or self-harm
- There’s been a medical event related to use (overdose, blackout with injury)
Frequently Asked Questions
Can I administer the CRAFFT to my teen at home?
You can, though teens tend to answer more honestly when a healthcare provider administers it confidentially. If doing it at home, consider letting them complete it privately online and then discussing results together.
What’s the difference between a CRAFFT score of 2 and a score of 4?
Both are positive screens. A score of 2 suggests moderate risk and the need for brief intervention and monitoring. Scores of 3–4 suggest higher risk. Scores of 5–6 are strongly associated with diagnosable substance use disorder requiring intensive intervention.
My teen scored 1. Should I still be concerned?
A score of 1 falls below the clinical cutoff, but one positive answer still indicates some risk behavior. The AAP recommends a brief conversation and continued monitoring. And some teens underreport, so a score of 1 with visible behavioral changes deserves follow-up.
