Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT 2.1)

9-question screener for substance use in adolescents

CRAFFT 2.1 Screening Test

The CRAFFT Screening Test is a 9-question screener for alcohol and drug use in adolescents (generally ages 12-21). A positive screening should be further evaluated by a clinical interview for additional assessment.

1. Have you ever ridden in a CAR driven by someone (including yourself) who was high or had been using alcohol or drugs?

Please answer question 1.

2. Do you ever use alcohol or drugs to RELAX or feel better about yourself or to fit in?

Please answer question 2.

3. Do you ever use alcohol or drugs when you are ALONE?

Please answer question 3.

4. Do you ever FORGET things you did while using alcohol or drugs?

Please answer question 4.

5. Do your FAMILY or FRIENDS ever tell you to cut down on your use of alcohol or drugs?

Please answer question 5.

6. Have you ever gotten into TROUBLE while you were using alcohol or drugs?

Please answer question 6.

7. In the past 12 months, have you used alcohol or drugs?

Please answer question 7.

8. In the past 12 months, have you used marijuana?

Please answer question 8.

9. In the past 12 months, have you used anything else to get high?

Please answer question 9.

The CRAFFT 2.1 is a widely used, evidence-based screening tool designed to identify adolescents and young adults (typically ages 12–21) who may be at risk for substance use disorders (SUDs). Its name is an acronym derived from key words in the questions: Car, Relax, Alone, Forget, Friends, and Trouble. Developed by Dr. Peter M. Monti and colleagues at Brown University, and later refined to version 2.1 to improve sensitivity and clinical utility, the CRAFFT helps clinicians quickly assess whether a young person may benefit from further evaluation or early intervention.

What Does CRAFFT Stand For?

Each letter corresponds to one of six core questions (plus two additional questions in version 2.1), all focused on substance use behaviors over the past 12 months:

C – Car: "Have you ever ridden in a car driven by someone (including yourself) who was ‘high’ or had been using alcohol or drugs?"
R – Relax: "Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?"
A – Alone: "Do you ever use alcohol or drugs while you are by yourself, alone?"
F – Forget: "Do you ever forget things you did while using alcohol or drugs?"
F – Friends: "Do one or more of your family or friends ever tell you that you should cut down on your drinking or drug use?"
T – Trouble: "Have you ever had a drink or used drugs and then gotten into trouble — for example, got into fights, missed school, gotten into legal trouble, or had problems at home?"

In addition to these six questions, the CRAFFT 2.1 includes two follow-up screening questions to assess frequency and quantity of use if the youth answers “yes” to any of the first six:

Q7: "How often have you used alcohol or drugs in the last year?"
Q8: "On how many days in the past 30 days did you drink alcohol or use drugs (not just a few sips)?”

How Is CRAFFT 2.1 Scored?

Scoring is straightforward:

Each “yes” answer to questions 1–6 counts as 1 point.
A score of ≥2 suggests increased risk for substance use disorder and warrants further assessment (e.g., with a comprehensive clinical interview or validated diagnostic tools like the ASAD-PL or ADHS).
In some settings, clinicians may consider scores of ≥1 in younger adolescents or those with other risk factors (e.g., mental health concerns), depending on context and developmental appropriateness.

Note: A “yes” to Q7 or Q8 alone does not indicate risk unless paired with ≥2 positive responses to the initial six questions.

Why Is CRAFFT Valuable?

Brief & Efficient: Takes just 2–3 minutes to administer.
Validated in Youth Populations: Proven sensitive (87%) and specific (79–86%) for detecting substance use disorders in adolescents.
Non-Stigmatizing Language: Uses open-ended, non-judgmental phrasing that encourages honest responses.
Developmentally Appropriate: Focuses on peer influence, risk contexts (e.g., driving under the influence), and functional consequences—key concerns during adolescence.
Facilitates Motivational Interviewing: The screening process can naturally lead to discussions about substance use patterns, goals, and readiness to change.

Limitations & Considerations

Not diagnostic: A positive screen requires clinical follow-up.
May underreport in youth who minimize or deny use (especially in face-to-face interviews).
Cultural and linguistic adaptations are recommended for diverse populations.
Less validated in adults; primarily intended for ages 12–21.

Clinical Use Cases

Primary Care: Integrated into routine well-child visits or adolescent health check-ups.
Emergency Departments & Urgent Care: Helps identify substance-related risks during acute visits (e.g., injury, overdose).
School Health Centers & Behavioral Health Settings: Used to triage need for counseling or treatment referrals.
Telehealth: Easily administered via voice or chat in virtual encounters.

Ethical and Developmental Considerations

Adolescents deserve confidentiality in sensitive discussions. Providers should clarify limits of confidentiality upfront (e.g., “I will keep most things you tell me private, except if you or someone else is in danger”). Using CRAFFT in a supportive, non-punitive manner can foster trust and promote healthy decision-making.

In Summary

The CRAFFT 2.1 is more than just a questionnaire—it’s a gateway to compassionate, proactive care for young people navigating the complex world of substance use. By asking about car, relax, alone, forget, friends, and trouble in a structured yet empathetic way, clinicians can uncover hidden risks and open doors to early support—potentially altering trajectories toward long-term health and well-being.

“The goal isn’t just screening—it’s connection. Every ‘yes’ is an invitation to listen, to understand, and to help.”

References & Resources

Knight, K., et al. (2013). Validation of the CRAFFT: A review of psychometric properties. Journal of Substance Abuse Treatment.
Centers for Disease Control and Prevention (CDC): Adolescent Screening for Alcohol and Other Drug Use.
Society for Adolescent Health and Medicine (SAHM): CRAFFT guidelines and training materials.