CRAFFT 2.1 Screening Tool
Adolescent Substance Use Screening — Ages 12-21
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CRAFFT 2.1 Substance Use Screening
This screening has two parts. Answer Part A first. Depending on your answers, you may be asked additional questions in Part B.
Understanding CRAFFT
What Does CRAFFT Screen For?
The CRAFFT 2.1 is the most widely used and validated screening tool for identifying substance use, substance-related riding risk, and substance use disorders among adolescents ages 12-21. The name is a mnemonic of the key words in the six screening questions: Car, Relax, Alone, Forget, Friends/Family, and Trouble.
Who Is CRAFFT Designed For?
CRAFFT was specifically developed and validated for adolescents and young adults ages 12-21. It is recommended by the American Academy of Pediatrics (AAP) as part of routine adolescent well-visits and is endorsed by numerous medical organizations worldwide.
How Is CRAFFT Used in Pediatric Settings?
Clinical Workflow
- Administered during annual well-visits or acute care visits
- Part A screens for past-year substance use
- Part B assesses risk behaviors related to substance use
- Takes less than 5 minutes to complete
Scoring & Follow-Up
- Only Part B questions are scored (0-6)
- Score of 0: No risk identified — reinforce healthy choices
- Score of 1: Low risk — brief advice and education
- Score of 2+: Positive screen — further assessment needed
Two-Part Adaptive Design
The CRAFFT uses a smart two-part structure. Part A asks about any alcohol, marijuana, or other substance use in the past 12 months. If all Part A answers are "No," only the Car question (B1) is asked, since riding with an impaired driver is a risk even for non-users. If any Part A answer is "Yes," all six Part B questions are administered to assess the full spectrum of substance-related risk behaviors.
Important Note
The CRAFFT is a screening tool, not a diagnostic instrument. A positive screen does not mean a teen has a substance use disorder. It means further evaluation by a qualified healthcare professional is recommended.
Teen Substance Use
Prevalence Among Adolescents
Substance use among teens remains a significant public health concern. According to the Monitoring the Future survey and NIDA data:
- By 12th grade, approximately 46% of teens have tried an illicit drug at least once
- About 30% of high school seniors report alcohol use in the past 30 days
- Marijuana use has remained relatively stable, with about 22% of 12th graders reporting past-month use
- Vaping has emerged as a major concern, with nicotine and THC vaping rising sharply
Impact on the Developing Brain
The adolescent brain continues developing until approximately age 25, with the prefrontal cortex (responsible for judgment, decision-making, and impulse control) being one of the last areas to mature. Substance use during this critical window can:
Short-Term Effects
- Impaired memory and learning ability
- Reduced academic performance
- Increased risk-taking behavior
- Altered mood regulation and emotional processing
Long-Term Consequences
- Structural changes in brain regions critical for learning
- Higher risk of developing substance use disorders as adults
- Potential reduction in IQ with heavy marijuana use before age 18
- Increased vulnerability to mental health disorders
Risk Factors vs. Protective Factors
Risk Factors
- Family history of substance use disorders
- Early onset of use (before age 14)
- Peer pressure and substance-using friends
- Mental health conditions (anxiety, depression, ADHD)
- Adverse childhood experiences (ACEs)
- Low parental monitoring and involvement
Protective Factors
- Strong family bonds and open communication
- Parental involvement and monitoring
- Academic engagement and school connectedness
- Healthy peer relationships
- Community involvement (sports, clubs, volunteering)
- Strong problem-solving and refusal skills
Gateway Theory vs. Reality
The traditional "gateway drug" theory suggested that using "softer" substances like alcohol or marijuana inevitably leads to "harder" drugs. Modern research presents a more nuanced picture:
- Most people who try alcohol or marijuana do not progress to harder drugs
- Early substance use does correlate with increased risk, but it is not deterministic
- Genetic, environmental, and social factors play a much larger role than any single substance
- The concept of "common liability" — shared vulnerability factors — better explains patterns of substance use escalation
Talking to Teens About Substance Use
Starting the Conversation
Talking about substance use does not have to be confrontational or scary. Research shows that teens whose parents talk to them about drugs and alcohol are 50% less likely to use substances. Here are evidence-based approaches:
- Start early and talk often: Do not wait for a crisis. Begin age-appropriate conversations before adolescence
- Use natural openings: News stories, TV shows, or situations involving peers can provide non-threatening conversation starters
- Be curious, not accusatory: Ask open-ended questions like "What do you think about...?" rather than leading with accusations
- Listen more than you talk: Show genuine interest in their perspective and experiences
- Share facts, not fear: Teens respond better to honest, science-based information than scare tactics
Avoiding Confrontation
What NOT to Do
- Lecture or moralize extensively
- Use scare tactics or exaggerate dangers
- Dismiss their feelings or experiences
- Interrogate or demand confessions
- React with anger or punishment as first response
What TO Do
- Express concern from a place of love
- Validate their feelings and experiences
- Share your own values and expectations clearly
- Offer help without judgment
- Follow up consistently and show you care
Motivational Interviewing Basics for Parents
Motivational interviewing (MI) is an evidence-based communication technique used by counselors that parents can adapt. The core principles include:
- Express empathy: "I can see this is hard to talk about, and I appreciate you being honest with me"
- Develop discrepancy: Help teens see the gap between their goals and their behavior — "You mentioned wanting to make the team. How do you think this might affect that?"
- Roll with resistance: When they push back, avoid arguing. Instead, reflect their feelings — "It sounds like you feel I'm being unfair"
- Support self-efficacy: Express confidence in their ability to make good choices — "I know you have the strength to handle peer pressure"
When to Seek Professional Help
Consider professional intervention if you notice:
- Changes in friend groups, especially toward older or substance-using peers
- Declining grades or loss of interest in activities
- Secretive behavior, lying, or stealing
- Physical signs: bloodshot eyes, weight changes, unusual smells
- Mood changes: increased irritability, depression, or withdrawal
- Any CRAFFT score of 2 or higher
Help & Resources
Teen-Specific Treatment Options
Adolescent substance use treatment differs from adult treatment and should be developmentally appropriate. Options include:
- Outpatient counseling: Individual therapy sessions 1-2 times per week — the most common first step
- Intensive outpatient programs (IOP): 9-12 hours per week of structured treatment while living at home
- Adolescent group therapy: Peer-based programs designed specifically for teens
- Family therapy: Addresses family dynamics that may contribute to substance use
- Residential treatment: 24/7 care for more severe cases — typically 30-90 days
School-Based Resources
At Your School
- School counselors: First line of support — confidential and accessible
- Student Assistance Programs (SAP): Many schools have substance abuse intervention programs
- School-based health centers: Offer confidential screenings and referrals
- Peer support groups: Programs like Natural Helpers or peer mediation
Know Your Rights
- Minors can consent to substance abuse treatment in most states
- Confidentiality protections exist under federal law (42 CFR Part 2)
- School-based counseling is generally confidential with few exceptions
- Your records are protected — treatment cannot be disclosed without consent
Helplines & Online Resources
Parent Support Groups
- Al-Anon / Alateen: Support for families affected by someone's drinking — al-anon.org
- Nar-Anon: Support for families affected by drug addiction — nar-anon.org
- CRAFT (Community Reinforcement and Family Training): Evidence-based approach for families — helps families motivate loved ones to enter treatment
- SMART Recovery Family & Friends: Science-based support program — smartrecovery.org
Frequently Asked Questions
The CRAFFT is the most widely used and validated screening tool for identifying substance use risk in adolescents and young adults ages 12-21. Developed by Dr. John R. Knight and colleagues at Boston Children's Hospital, it stands for the key words in its six questions: Car, Relax, Alone, Forget, Friends/Family, and Trouble. Version 2.1 includes an updated Part A that screens for past-year use of alcohol, marijuana, and other substances before proceeding to the six CRAFFT questions. It is recommended by the American Academy of Pediatrics for routine screening during adolescent healthcare visits.
The CRAFFT 2.1 is designed for adolescents and young adults ages 12-21. It is recommended as a universal screening tool during routine medical visits, meaning it should be offered to all adolescents regardless of whether substance use is suspected. Parents, school counselors, and teens themselves can also use this screening as a starting point for discussion. For adults over 21, other screening tools such as the AUDIT (for alcohol) or CAGE-AID (for substances) may be more appropriate.
A CRAFFT score of 2 or higher is considered a "positive" screen, meaning there is an elevated risk of substance use problems that warrants further assessment. A positive result does not mean you have a substance use disorder — it means a more thorough evaluation by a healthcare professional is recommended. Think of it like a temperature check: a fever tells you something may be wrong, but you need further evaluation to determine the cause. Many teens with a positive screen may benefit from a brief conversation with a counselor or doctor.
If you are concerned about your results, talking to a trusted adult is strongly recommended. This could be a parent, school counselor, doctor, or another trusted adult. Many teens worry about getting in trouble, but most parents and healthcare providers want to help, not punish. Healthcare providers are bound by confidentiality rules and will work with you to create a safe space for honest conversation. In most states, minors can access substance abuse treatment without parental consent. Your doctor can explain what confidentiality protections apply in your situation.
There are many free, confidential resources available to teens:
- SAMHSA National Helpline: 1-800-662-4357 — free, confidential, 24/7 treatment referral
- Crisis Text Line: Text HOME to 741741 for free crisis counseling
- Your school counselor: Available during school hours and trained to help
- Your primary care doctor: Annual visits include confidential time to discuss concerns
- Teen Line: 1-800-852-8336 — teens helping teens
- Partnership to End Addiction: drugfree.org — resources for both teens and parents
Remember: asking for help is a sign of strength, not weakness. Many teens go through similar challenges, and effective treatments are available.
Medical Disclaimer
This CRAFFT 2.1 Screening Tool is provided for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
- The CRAFFT is a screening tool, not a diagnostic instrument.
- A positive screen does not mean you have a substance use disorder.
- Only a qualified healthcare provider can diagnose substance use disorders.
- Always consult a healthcare professional for proper evaluation and guidance.
Privacy: All calculations happen in your browser. We do not store your responses.
Attribution: CRAFFT 2.1, The Center for Adolescent Substance Abuse Research (CeASAR), Boston Children's Hospital.
References & Sources
- Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of Pediatrics & Adolescent Medicine. 2002;156(6):607-614. PubMed
- Knight JR, Harris SK, Sherritt L, et al. Validity of brief alcohol screening tests among adolescents: A comparison of the AUDIT, POSIT, CAGE, and CRAFFT. Alcoholism: Clinical and Experimental Research. 2003;27(1):67-73. PubMed
- Mitchell SG, Kelly SM, Gryczynski J, et al. The CRAFFT cut-points and DSM-5 criteria for alcohol and other drugs: a re-evaluation and re-examination. Substance Abuse. 2014;35(4):312-318. PubMed
- Dhalla S, Zumbo BD, Poole G. A review of the psychometric properties of the CRAFFT instrument: 1999-2010. Current Drug Abuse Reviews. 2011;4(1):57-64. PubMed
- Levy SJL, Williams JF; Committee on Substance Use and Prevention. Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics. 2016;138(1):e20161211. PubMed
Last Updated: February 2026