Embedding the Crafft Screen for Substance Use Among Adolescents into the Youth Risk Behavior Survey *

BACKGROUND:   The CRAFFT (Car, Relax, Alone, Friends, Forget, Trouble) is a validated 6-item survey to assess alcohol and other drug (AOD) use among adolescents and identifies those requiring further assessment.  Additionally, the score is correlated with the severity of diagnostic classification of AOD use, allowing the identification of adolescents who may have progressed to substance dependence.  In 2011 and 2013, the state of Hawaii embedded the CRAFFT screening questions in its Youth Risk Behavior Survey (YRBS).  This report presents the findings from the state for the CRAFFT screen relative to existing AOD use measures.

METHODS:   The 2011 High School YRBS for the state of Hawaii was used to examine AOD use behaviors among public students in grades 9-12.  The CRAFFT screen is based on 6 questions, with each ‘Yes’ response adding 1 point to the score, for a range of 0-6.  A score of 2 or greater (CRAFFT 2+) indicates the need for further assessment for problem AOD use.  A score of 4 or greater (CRAFFT 4+) may signify substance dependence.  In a clinical setting, the CRAFFT screen is administered to adolescents who report recent AOD use.  Therefore, this YRBS analysis was limited to students who reported using alcohol or marijuana in the previous 30 days.

RESULTS:   Among public high school students in Hawaii, 36.9% reported using either alcohol or marijuana in the previous 30 days.  Among these students, 65.9% had a CRAFFT 2+ score and 45.2% had a CRAFFT 4+ score.  Relative to those scoring 0 or 1, students with a CRAFFT 2+ score were significantly more likely to report daily alcohol consumption (OR=3.10, CI:1.19-8.06) and frequent binge drinking (10+ times in past 30 days; OR=7.37, CI:2.49-21.84).  Heavy marijuana use (40+ times in past 30 days) was also more likely among students with a CRAFFT 2+ score (OR=4.50, CI:2.54-8.00) as was a lifetime history of illicit drug use (OR=3.07, CI:1.98-4.76).  These odds increase among students with a CRAFFT 4+ score.

CONCLUSIONS:   In the state of Hawaii, almost 37% of high school students report having used alcohol or marijuana in the past 30 days.  Nearly 66% of these students meet the criteria for assessment for problem AOD use and abuse.  More than 45% may already be substance dependent.  Although the YRBS core questions provide valuable prevalence and frequency information about AOD use among students, the inclusion of the CRAFFT screening tool offers additional data for measuring the severity of substance use, abuse, and dependence.