The CRAFFT Screening Tool: What It Is and How to Use It

Substance use among adolescents continues to be a critical concern for healthcare providers, educators, and behavioral health professionals. Early identification is key to prevention and intervention — but traditional screening tools designed for adults often fail to capture the unique risks and behaviors of younger populations. That’s where the CRAFFT screening tool comes in.

Specifically developed to address the developmental and psychosocial needs of youth ages 12 to 21, the CRAFFT offers a validated, adolescent-focused method for detecting high-risk substance use. This evidence-based tool not only flags potential substance use issues but also facilitates meaningful conversations between clinicians and young people, fostering greater insight and motivation for change.

In this article, we’ll explore what the CRAFFT screening tool is, how it works, and why it remains a trusted standard for youth substance use screening across a variety of clinical and community settings.

What is the CRAFFT screening tool?

The CRAFFT screening tool, developed by the Center for Adolescent Behavioral Health Research (CABHRe, formerly CeASAR), is a widely recognized and evidence-based instrument for identifying high-risk substance use among adolescents and young adults. Specifically designed for youth aged 12 to 21, the CRAFFT is a validated screening tool that has proven effective across diverse racial, ethnic, and socioeconomic groups.

Using a screening tool tailored to adolescents is critical, as adult-focused tools lack validation for younger populations and may miss key risk indicators. Employing a validated instrument like the CRAFFT ensures more accurate and developmentally appropriate assessments of youth substance use.

It’s important to note that the CRAFFT is not a replacement for a comprehensive clinical interview. Rather, it serves as a structured conversation starter, helping clinicians delve deeper into potential substance use issues during follow-up discussions.

What does CRAFFT stand for?

The name of the CRAFFT screening tool is a mnemonic for the specific problem areas assessed by this screening tool:

• C: Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
• R: Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
• A: Do you ever use alcohol or drugs while you are by yourself, ALONE?
• F: Do you ever FORGET things you did while using alcohol or drugs?
• F: Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
• T: Have you gotten into TROUBLE while you were using alcohol or drugs?

When is the CRAFFT screening tool used?

Although the CRAFFT screening tool was initially created for adolescents in primary care environments, it has since been validated for use across a wide range of clinical settings. This versatility makes it a valuable resource whenever there are concerns about potential substance use among younger populations.

In addition to targeted assessments, the CRAFFT supports universal screening practices — a key recommendation of the Bright Futures Guidelines from the American Academy of Pediatrics (2022). By aligning with these best-practice guidelines, the CRAFFT screening tool helps healthcare providers proactively identify and address risky substance use in adolescent populations.

How do you interpret the CRAFFT score?

The CRAFFT screening tool is designed not only to detect problematic substance use among adolescents but also to gauge the potential severity of use. A score of 2 or more is associated with an increased risk for a DSM-5-TR™ substance use disorder, making it a critical threshold for initiating a clinical response. Higher scores typically indicate more severe substance involvement, guiding providers in tailoring appropriate interventions.

Following the screening, results should inform brief counseling sessions grounded in a motivational enhancement approach. This method aims to foster self-awareness and readiness for change by helping youth explore how substance use may conflict with their personal goals and values.

The latest version of CRAFFT includes the “5 R’s” talking points, a structured guide for conducting effective brief interventions with adolescents:

1. Review the screening results together
2. Request additional information for any “yes” answers in Part B
3. Recommend abstinence from alcohol and drug use
4. Reinforce the risks — emphasizing how substances impair memory, harm brain development, and increase the likelihood of dangerous or embarrassing situations
5. Riding/driving risk reduction — provide counseling around the dangers of riding with or driving under the influence

To further support behavior change, the CRAFFT developers offer a Contract for Life (or Pledge for Life), which encourages adolescents to discuss safe transportation plans with their caregivers. These tools, along with guided discussion, aim to elicit self-motivational statements and build self-efficacy — helping teens recognize the benefits of abstaining from substances and believe in their ability to make healthy choices.