During an annual well-visit, a 16-year-old boy completes the CRAFFT screening tool privately on a tablet. He answers "yes" to riding in a car driven by someone (including himself) who had been using alcohol or drugs, "yes" to using alcohol or drugs while alone, and "yes" to friends or family telling him to cut down. He answers "no" to the remaining items. Based on his CRAFFT score, what is the nurse practitioner's most appropriate next action?

Question

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✅ B. Conduct a brief motivational interviewing conversation and arrange follow-up for further substance use assessment
A CRAFFT score of ≥2 is a positive screen and indicates the adolescent is at high risk for a substance use disorder, requiring further assessment. This patient scores 3 (Car, Alone, Friends). Best practice (AAP and the Center for Adolescent Substance Use and Addiction Research) is to follow a positive screen with a brief intervention using motivational interviewing in the moment, then arrange follow-up for a more detailed assessment, possible referral to treatment, and coordinated care. The visit also offers an opportunity to provide harm reduction (don't ride with intoxicated drivers) and confidentiality counseling.

❌ A. Reassure the adolescent that occasional adolescent experimentation is normal and document the screen as negative
A score ≥2 is a positive screen, not a negative one. Minimizing this finding misses an evidence-based opportunity for early intervention and contradicts the purpose of the CRAFFT tool.

❌ C. Disclose the screening results to the parents during the visit so they can intervene at home
Adolescent confidentiality is foundational to honest screening. Disclosing positive screen details to a parent without the adolescent's permission breaks trust, violates AAP confidentiality guidance, and is only justified when there is imminent danger (suicidal/homicidal intent, life-threatening overdose risk). General substance use is not an automatic exception.

❌ D. Order a urine drug screen and base the next steps on the result
A urine drug screen is not a recommended response to a positive CRAFFT in primary care. Drug testing without consent has consent, confidentiality, and ethical issues; the CRAFFT is a self-report screen that already informs next steps. Drug testing has a limited role and should be done only with the adolescent's informed consent and a clear clinical purpose.

:::tip
CRAFFT = Car, Relax, Alone, Forget, Friends, Trouble. Score ≥2 = positive. The next step is conversation (brief intervention + assessment), not parents, not a urine drug screen.
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CRAFFT

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CRAFFT

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