Predictive Validity of the CRAFFT for Substance Use Disorder

Area of Science:

• Adolescent Health
• Psychiatry
• Emergency Medicine

Background:

• Problematic substance use and substance use disorders (SUDs) are significant concerns in adolescents.
• The CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening tool's utility in pediatric emergency departments (PEDs) for identifying SUDs is not well-established.

Purpose of the Study:

• To determine the concurrent and predictive validity of the CRAFFT tool for identifying current and future SUDs in patients within PEDs.

Main Methods:

• A secondary analysis was performed on data from 16 PEDs.
• 4753 participants aged 12-17 completed baseline assessments, including the CRAFFT, alcohol, drug use, and risk behavior measures.
• A subsample underwent 1-, 2-, and 3-year follow-up assessments to evaluate future SUDs.

Main Results:

• A baseline CRAFFT score of ≥2 was significantly associated with problematic substance use and SUD diagnoses at baseline and persisted over 3 years (P < .001).
• A CRAFFT cutoff of ≥1 best predicted problematic substance use and mild SUD diagnoses at 1, 2, and 3 years.
• Predicting moderate to severe SUDs varied, with a cutoff of ≥2 at 1 year and ≥1 at 2 and 3 years.

Conclusions:

• The CRAFFT tool demonstrates good concurrent validity for problematic substance use and SUDs in PED patients.
• CRAFFT is valuable for predicting SUDs up to 3 years post-screening in this population.
• The study highlights limitations in the sensitivity of the CRAFFT tool for predicting SUDs.