CORK Bibliography: CRAFFT (Adolescent Screening Test)

7 citations. 2000 to present

Prepared: September 2007

Bernard M; Bolognini M; Plancherel B; Chinet L; Laget J; Stephan P; Halfon O. French validity of two substance-use screening tests among adolescents: A comparison of the CRAFFT and DEP-ADO. Journal of Substance Use 10(6): 386-395, 2005. (30 refs.)

Aim: The objective of this study was to compare the criterion validity of the CRAFFT and DEPADO. Method: One hundred and sixty-three adolescents (80 from the general population and 83 regular substance users) completed the ADAD and the MINI questionnaires, as well as either the CRAFFT or the DEP-ADO in roughly equal proportions, between March 2002 and August 2003. Sensitivity and specificity were calculated. Results: Both questionnaires had high sensitivity but the DEP-ADO showed a better specificity than CRAFFT. A score equal or higher than 8 on the scale of DEP-ADO appeared to be an appropriate threshold for problems related to substance use. DEP-ADO had a sensitivity of 92.0% and a specificity of 80.6% with severity rating scores of ADAD (alcohol and drug areas combined). With the MINI diagnoses, DEP-ADO had a sensitivity of 95.1% and a specificity of 68.9%. Conclusion: DEP-ADO appears to have higher diagnostic utility for identifying substance use than CRAFFT in regard to sensitivity and specificity. However, the CRAFFT has the advantage of considering substance use over a lifetime period. Further studies should be targeting younger subjects and more diverse substance-use patterns.

Burke PJ; O'Sullivan J; Vaughan BL. Adolescent substance use: Brief interventions by emergency care providers. (editorial). Pediatric Emergency Care 21(11): 770-776, 2005. (31 refs.)

Use of tobacco, alcohol and other drugs plays a major role in adolescent morbidity and mortality. When under the influence of alcohol or other drugs, adolescents are at increased risk for injuries, unprotected sex, or interpersonal violence. Alcohol and other drugs are major factors in adolescent deaths, contributing to motor vehicle crashes, homicides, and suicides. Adolescents tend to have shorter substance use histories therefore they often experience emergency/acute care health treatment resulting from Substance use related trauma and/or overdose. Substance use screening of adolescents who present to an Emergency Department (ED) is vitally important. The CRAFFT is a valid and reliable screening tool that was developed for use with adolescents. If an adolescent screens positive, then the next step is to determine their stage of use and readiness for change in preparation for doing a brief intervention. Helping patients to recognize the potential relation between their substance use and health related consequences, may motivate them to decrease their use for harm reduction. Motivational interviewing is an effective, evidence-based approach to helping people change their high risk behavior.

Cummins LH; Chan KK; Burns KM; Blume AW; Larimer M; Marlatt GA. Validity of the CRAFFT in American-Indian and Alaska-native adolescents: Screening for drug and alcohol risk. Journal of Studies on Alcohol 64(5): 727-732, 2003. (36 refs.)

Objective: Native-American adolescents are reported to be at high risk for drug and alcohol use and related negative consequences. A brief screening instrument that is culturally and developmentally appropriate can aid clinicians who work with Native youth in determining whether more extensive assessment of substance use is necessary The CRAFFT has been shown to be a valid and reliable screen among general adolescent outpatient clinic samples. Method: Data were collected as part of the Journeys of the Circle project, a collaborative effort between the Seattle Indian Health Board (SIHB) and the University of Washington's Addictive Behaviors Research Center. Psychometric properties of the CRAFFT were examined in 70 American-Indian and Alaska-Native youths ages 13 to 19 recruited from public schools and SIHBs outpatient clinics. Results: The CRAFFT demonstrated good internal consistency (alpha = 0.81). A score of 2 or higher on the CRAFFT was found to be optimal for capturing youths with high alcohol-related problems (sensitivity, 0.95; specificity, 0.86), frequent alcohol use (sensitivity, 1.00; specificity, 0.72) and frequent marijuana use (sensitivity, 1.00; specificity, 0.75). A cut-point of 3 was appropriate for identifying adolescents with frequent other drug use (sensitivity, 0.86; specificity, 0.76). Conclusions: The CRAFFT may be a valid instrument for identifying Native youths at risk for alcohol and other drug problems. This brief screen can be effective in helping providers determine the need for further assessment and treatment or prevention services for Native-American adolescents.

Kelly TM; Donovan JE; Chung T; Cook RL; Delbridge TR. Alcohol use disorders among emergency department-treated older adolescents: A new brief screen (RUFT-Cut) using the AUDIT, CAGE, CRAFFT, and RAPS-QF. Alcoholism: Clinical and Experimental Research 28(5): 746-753, 2004. (43 refs.)

Background: Early identification of alcohol use disorders (AUD) among emergency department (ED)-treated patients is important for facilitating intervention and further evaluation outside EDs. A number of brief screening instruments have been developed for identifying patients with AUD, but it is not clear whether they are practical and perform well with older adolescents in an ED setting. This study contrasted four brief screening instruments for detecting DSM-IV-defined AUD and tested a newly developed brief screen for use among ED-treated older adolescents.Methods: The Alcohol Use Disorders Identification Test (AUDIT), the CAGE, the CRAFFT, and a modified RAPS-QF were given to 93 alcohol-using older adolescents (55% men; aged 18-20 years) in an ED. Receiver operator characteristic analyses were used to evaluate the performance of brief screens against the criterion of a lifetime DSM-IV alcohol abuse or dependence diagnosis.Results: Of existing instruments, the AUDIT had the best overall performance in identifying AUD (sensitivity, 82%; specificity, 78%). A new, shorter screening instrument composed of two AUDIT items, two CRAFFT items, and one CAGE item (RUFT-Cut) performed as well as the AUDIT (sensitivity, 82%; specificity, 78%).Conclusions: Among existing alcohol screening instruments, the AUDIT performed best for identifying ED-treated older adolescents with alcohol use disorders. The RUFT-Cut is a brief screening instrument for AUD that shows promise for identifying ED-treated older adolescents who are in need of intervention or further evaluation. Future research should focus on use of the RUFT-Cut in other settings with larger, more diverse samples of adolescents.

Knight JR; Sherritt L; Harris SK; Gates EC; Chang G. Validity of brief alcohol screening tests among adolescents: A comparison of the AUDIT, POSIT, CAGE, and CRAFFT. Alcoholism: Clinical and Experimental Research 27(1): 67-73, 2003. (48 refs.)

Background: Adolescents should be screened for alcohol misuse as part of routine care. The objective of this study was to compare the criterion validity of the Alcohol Use Disorders Identification Test (AUDIT), the Problem Oriented Screening Instrument for Teenagers substance use/abuse scale (POSIT), and the CAGE and CRAFFT questions among adolescents. Methods: Fourteen- to 18-year-old patients arriving for routine healthcare at a large, hospital-based adolescent clinic completed the four screens and the criterion standard Adolescent Diagnostic Interview, which yields DSM-IV diagnoses of alcohol abuse and dependence. Receiver operating characteristic (ROC) curves were plotted to determine optimal cut-points. Areas under the ROC curves of the four screens were compared, and sensitivities and specificities were calculated. Results: Participants' past 12-month alcohol diagnostic classifications were as follows: no use (58.6%), nonproblem use (13.0%), problem use (20.8%), abuse (5.4%), and dependence (2.2%). Optimal cut-points associated with problem use or higher were 2 for AUDIT, I for POSIT, 1 for CAGE, and 1 for CRAFFT. ROC curve area of the CAGE was significantly lower compared with areas of all other screens. Sensitivities (95% confidence intervals) were AUDIT 0.88 (0.83-0.93), POSIT 0.84 (0.79-0.90), CAGE 0.37 (0.29-0.44), and CRAFFT 0.92 (0.88- 0.96); specificities were AUDIT 0.81 (0.77-0.85), POSIT 0.89 (0.86-0.92), CAGE 0.96 (0.94-0.98), and CRAFFT 0.64 (0.59- 0.69). Conclusions: The AUDIT, POSIT, and CRAFFT have acceptable sensitivity for identifying alcohol problems or disorders in this age group. The CAGE is not recommended for use among adolescents.

Levy S; Sherritt L; Harris SK; Gates EC; Holder DW; Kulig JW et al. Test-retest reliability of adolescents' self-report of substance use. Alcoholism: Clinical and Experimental Research 28(8): 1236-1241, 2004. (26 refs.)

Background: Adolescent substance abuse is a serious problem for which effective interventions are needed. To conduct trials of new therapies, investigators need reliable means of identifying potential participants and of measuring outcomes. The objective of this study was to determine the 1-week test-retest reliability of the CRAFFT screening test and of the timeline follow-back (TLFB) calendar method for measuring alcohol, cannabis, and other drug use. Methods: Ninety-three 12- to 18-year-old patients presenting for routine medical care to three urban adolescent clinics were administered the CRAFFT screen in both lifetime and past-year versions and a 90-day TLFB. Both measures were completed on the day of the clinic visit and again 1 week later. We computed K coefficients and the intraclass correlation coefficient (ICC) for the CRAFFT and computed the ICC separately for TLFB self-reports of alcohol and cannabis. Results: For the CRAFFT, kappa for individual items ranged from 0.31 to 0.86, and the ICC was 0.93 (95% confidence interval, 0.90-0.95). However, the total score of the lifetime CRAFFT at time 2 was significantly lower than at time 1; there was no difference in time 1 and time 2 total scores for the past-year version. The ICCs for past-90-days TLFB variables were as follows: drinking days, 0.92; drinks per occasion, 0.87; cannabis days, 0.83; and joints per occasion, 0.76. Past-30-day and past-60-day intervals compared favorably to past-90-day intervals. Conclusions: The CRAFFT screen is a reliable means of screening adolescents for substance abuse, although we recommend using the past-year version. The TLFB is a reliable method of quantifying adolescents' alcohol and cannabis use at intervals of 30, 60, or 90 days.

Nevitt JR; Lundak J; Galardi G. Profile of adolescent alcohol offenders in two rural midwestern counties. Psychological Reports 98(2): 379-384, 2006. (25 refs.)

Screening tools specifically developed for use with adolescents may be more sensitive predictors of relapse or recidivism than self-report inventories typically used to screen adults. 70 adolescents in a program for drunk drivers in two counties in southeastern Nebraska were given both the CRAFFT and the Alcohol Use Disorder Identification Test questionnaires during routine alcohol-dependency evaluations. The Michigan Alcoholism Screening Test was also given to 28 subjects selected at random. 11 boys and 6 girls did not successfully complete the program. Significant correlations obtained for AUDIT scores for both the CRAFFT (r(69) = .65, p < .01) and failure to complete diversion (r(69) = .23, p < .05). Subjects were grouped by age (18 and younger and over 18 years) and by sex. A 2 x 2 analysis of variance for scores on the AUDIT indicated significant main effects for both age (F-1,F-66 = 4.86, p < .05) and sex (F-1.66 = 5.96, p < .01). MAST and CRAFFT scores showed no age or sex differences. The AUDIT might be included in drug and alcohol assessments with similar samples of adolescents.