CRAFFT
Adolescent Substance Use Screen
≥2 yes → further assessment; brief intervention and referral if indicated.
Memory aids matter when the test asks for an exhaustive list under time pressure. CRAFFT is the validated 6-question screen for adolescent substance use risk, used by NPs across primary care and adolescent medicine: Car, Relax, Alone, Forget, Family/Friends, Trouble. A score of 2 or more triggers a brief intervention or referral. The AANP exam typically presents a vignette where a teen acknowledges occasional alcohol use and asks the NP what to ask next or how to score the encounter. Knowing what each letter stands for, what counts as a positive answer, and the 2-point threshold lets you triage quickly without re-reading the question.
- CCarEver ridden in a Car driven by someone (including yourself) who was high or had been using alcohol or drugs?
- RRelaxEver use to Relax, feel better about yourself, or fit in?
- AAloneEver use while Alone?
- FForgetEver Forget things you did while using?
- FFamily / FriendsDo Family or Friends ever tell you to cut down?
- TTroubleEver gotten into Trouble while using?
Clinical Context
Validated screen for ages 12-21, endorsed by AAP and SAMHSA. The "Car" question should never be skipped — it screens for the single highest acute risk (MVC) and applies even when the teen denies use themselves.
Pairs naturally with HEADSS — CRAFFT slots into the "D" (drugs) section. Administer with the parent out of the room and set confidentiality expectations upfront. A positive screen (≥2) warrants a brief intervention (motivational interviewing) and referral to treatment if use is severe. Report only what legal mandates require (e.g., imminent danger); don't breach confidentiality over a positive screen alone.
AANP adolescent-medicine stem: positive CRAFFT in a 16-year-old → your next step is brief intervention, not immediate parental disclosure.
Related Mnemonics
- CAGE — Alcohol Use Disorder Screening
- CIWA-Ar — Alcohol Withdrawal Severity
- DIG FAST — Manic Episode Criteria (DSM-5)
- HEADSS — Adolescent Psychosocial Assessment
- SAD PERSONS — Suicide Risk Assessment
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