What is the CRAFFT questionnaire?

The CRAFFT questionnaire is a brief, structured screening instrument whose name is a mnemonic: Car, Relax, Alone, Forget, Friends (family/friends), and Trouble. It is widely used in primary care, emergency, school-based, and behavioral health settings to identify adolescents and young adults who may be experiencing substance-related problems or risky use of alcohol or other drugs. CRAFFT is not a diagnostic tool for substance use disorders; it is a screen that helps clinicians decide when to pursue a more detailed assessment, safety planning, brief intervention, or referral.

The version most often cited in contemporary practice is CRAFFT 2.1, which asks about the past 12 months, uses clear yes/no responses, and frames questions in developmentally appropriate language. Because substance use is sensitive and may carry stigma or legal implications for young patients, screening is most effective when paired with confidential discussion, nonjudgmental tone, and clear explanation of privacy limits according to local law and institutional policy.

Why screen adolescents and young adults?

Substance use often begins in adolescence. Early identification offers a chance to address risky behaviors before they become entrenched, to identify co-occurring mental health conditions, and to reduce harms such as impaired driving, injuries, academic or vocational disruption, and exposure to violence or exploitation. Brief validated screens like CRAFFT fit into time-limited visits because they require only a small number of targeted questions rather than an exhaustive substance use history.

CRAFFT is commonly integrated into broader prevention and early intervention frameworks (for example, screening followed by brief intervention and referral to treatment when appropriate). The questionnaire emphasizes consequences and contexts of use—such as using to cope with stress or using while alone—rather than only cataloging substances or quantities. That emphasis can help clinicians move quickly from “any use” to “is this pattern placing the young person at risk?”

The six CRAFFT items (mnemonic)

Each item is answered Yes or No for the timeframe specified in your protocol (standard CRAFFT 2.1: the past year).

C — Car

This item explores riding in a vehicle operated by someone who was impaired by alcohol or drugs, including situations where the young person themselves was the driver. It targets a concrete, high-risk behavior with immediate safety implications and is often easier for patients to acknowledge than abstract questions about “how much” they drink or use.

R — Relax

This question asks whether alcohol or drugs are used to relax, feel better about oneself, or fit in socially. Affirmative answers may signal self-medication for anxiety, low mood, or social pressure—patterns that warrant exploration of coping skills, peer context, and mental health symptoms.

A — Alone

Using substances while alone can reflect habitual or compulsive patterns and may be less visible to parents or schools than party-related use. It is a useful probe for escalation from purely social experimentation to more individualized use.

F — Forget

Forgetting events that occurred during intoxication points toward heavy use episodes, blackouts, or cognitive effects of substances. This item links substance use to neurocognitive risk and helps open a conversation about dose, frequency, and dangerous situations the patient may not fully recall.

F — Friends / family (concern from others)

The second “F” captures external concern: whether family members or friends have suggested cutting down on drinking or drug use. Social friction and expressed worry from people close to the patient are independent indicators that use may be causing observable problems in relationships or behavior.

T — Trouble

This item asks about getting into trouble related to substance use—such as school disciplinary action, legal involvement, fights, or other adverse events. Trouble-linked use often marks a threshold where structured assessment, safety planning, and coordination with schools or community resources may be appropriate.

Scoring the CRAFFT questionnaire

In the standard scoring scheme used by the CalcMD CRAFFT calculator, each Yes response counts as one point. Each No counts as zero. The total score therefore ranges from 0 to 6. The score is a simple arithmetic sum; it does not weight individual items differently.

Because CRAFFT is a screening instrument, the numeric total should always be interpreted in clinical context: developmental stage, acute safety concerns, co-occurring psychiatric symptoms, medical comorbidities, and local resources for follow-up care.

Interpreting CRAFFT score bands

Clinical guidelines and training materials commonly describe three practical bands. Exact workflows may vary by institution, but the following framework matches widely published teaching on CRAFFT 2.1 and is reflected in the CalcMD tool’s output.

• Score 0 (negative screen): No affirmative answers on any item. In many pathways this is treated as a negative screen on CRAFFT itself, with routine anticipatory guidance and periodic re-screening when clinically appropriate.
• Score 1 (indeterminate / needs further attention): A single “Yes” may represent isolated risky behavior or early problem use. Many clinicians pursue a brief structured follow-up (motivational interviewing, safety counseling, and clarifying questions about substances, frequency, and context) rather than stopping after a single positive response.
• Score 2 or higher (positive screen): Multiple affirmative responses raise concern for a substance-related problem pattern. This band typically triggers a more comprehensive substance use assessment (for example, criteria-based evaluation for substance use disorders), evaluation for co-occurring mental health conditions, and linkage to behavioral health, addiction medicine, or adolescent specialty services as available.

How to use the CalcMD CRAFFT calculator

The calculator presents the six standard CRAFFT 2.1 questions as yes/no choices. You should answer each item before calculating so the score reflects a complete screen. The tool displays:

• the total score from 0 to 6;
• a screen category aligned with the bands above;
• concise recommendation prompts suitable for education and clinical decision support;
• a list of which specific items were answered “Yes,” to support documentation and follow-up questioning.

The calculator is designed for transparency: it shows how the total was derived and which questions contributed points, which can help learners and clinicians align the screen with charting or quality-improvement workflows.

Clinical documentation and follow-up

When CRAFFT is positive or equivocal, documentation often includes the total score, the date of screening, a brief note on substances discussed (if elicited), acute safety issues, and the plan (brief intervention completed, follow-up scheduled, referral placed, resources provided). For adolescents, documentation should respect confidentiality rules applicable in your jurisdiction, including what may be shared with parents or guardians and under what circumstances.

Limitations and responsible use

CRAFFT relies on self-report, which can be affected by fear of punishment, shame, or lack of privacy. A negative screen does not guarantee absence of substance use, especially if the patient minimizes answers or has not yet experienced the types of problems the items probe. Conversely, a positive screen is not equivalent to a formal diagnosis; it indicates that further evaluation is warranted.

The CalcMD CRAFFT questionnaire calculator supports clinical education and structured screening workflows. It does not replace licensed medical or behavioral health evaluation, mandatory reporting obligations, or institutional policies governing adolescent confidentiality and substance use care.