‘CRAFFT'ing a Method to Identify Adolescent Substance Abuse

Substance abuse in adolescents is an important area of concern in the primary care setting. In this population, substance abuse, has been related to impaired ability for the adolescent brain to develop. This leads to unfavorable impact on memory, intelligence, sensitivity to reward, and ability to regulate emotions. Additionally, substance use disorder (SUD) can continue into adulthood causing further problems such as loss of productivity and inability to function in society. For such a serious issue, screening is often overlooked in the practice setting. Therefore, NPs have the opportunity to identify adolescent substance abuse and make interventions.

In an article recently published in theJournal for Nurse Practitioners, identifying adolescent substance abuse is easier said than done. Not only does communication with adolescents pose unique challenges, providers rarely use evidence-based forms of screening when available. Due to these obstacles, less than 10% of adolescents with SUD receive treatment and most of those who do receive it through the criminal justice system. In recent years, CRAFFT has been the screening instrument with the best evidence for use in primary care.

Each letter in the acronym represents a question:

1. “Have you ever ridden in aCar driven by someone (including yourself) who was high or has been using alcohol or drugs?”
2. “Do you ever use alcohol or drugs toRelax, feel better about yourself, or fit in?”
3. “Do you ever use alcohol or drugs when you are by yourself,Alone?”
4. “Do you everForget things while you are using alcohol or drugs?”
5. “Do your family orFriends ever tell you that you should cut down on your drinking or drug use?”
6. “Have you ever gotten intoTrouble while you were using alcohol or drugs?”

Each “yes” answer is equivalent to 1 point. A higher score is correlated with a greater likelihood of SUD.

In addition to CRAFFT, a new online screening tool has been created to identify substance useandstratify individuals based on risk level. The Screening to Brief Intervention (S2BI) tool asks a simple question regarding how many times the individual has used 8 different substances, including alcohol, marijuana, and tobacco in the past year. A study funded by the National Institute on Drug Abuse showed that if adolescents did not report tobacco, alcohol, or marijuana use during that time frame, they were not likely to be using any other substances. Furthermore, results indicated that asking “How many times?” instead of “Have you ever?” was more sensitive and specific for categorizing substance use (no use, use without SUD, mild or moderate SUD, or severe SUD). If the respondent reports use, additional questions based on the CRAFFT screening tool are asked.

If the individual indicates signs of substance use, different levels of intervention should be implemented depending on the level of risk that is identified. When the adolescent reports no use, health care professionals should give praise and encourage the individual to maintain being substance free. For those who fall under moderate risk, the individual should be educated to increase awareness of the negative impact associated with use. In severe cases, involvement of parents with or without the consent of the patient is advised.

The emergence of the CRAFFT and S2BI provide health care professionals with a simpler form of screening to aid in recognizing adolescent substance abuse. With increased sensitivity to communication challenges and an evidence-based approach, these screening tools are an advancement in identifying adolescent SUD and providing interventions.

This study was published in Journal for Nurse Practitioners. 2015;11(4):471-472.