The CRAFFT Cut-Points and DSM-5 Criteria for Alcohol and Other Drugs: A Reevaluation and Reexamination

Background The CRAFFT, previously validated against DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnostic criteria, is the most widely used screening instrument for alcohol and other substance misuse in adolescents. The present secondary analysis study sought to compare the CRAFFT with the new DSM-5 diagnostic criteria in order to assess the CRAFFT's psychometric properties and determine the optimal cut-point for identifying adolescents in need of further assessment. Methods Participants were primary care patients aged 12–17 (N = 525) who were recruited while waiting for a medical appointment in an urban federally qualified health center in Baltimore, Maryland, USA. Participants were administered the CRAFFT and the Composite International Diagnostic Interview, second edition, modified to include the new DSM-5 craving item. The authors examined the performance of the CRAFFT in identifying any problem use (defined as 1 or more DSM-5 criteria) and any DSM-5 substance use disorder (2 or more DSM-5 criteria) for alcohol or drugs other than tobacco. The authors examined sensitivity, specificity, and receiver operating characteristic areas under the curve (AUC) to determine the optimal CRAFFT cut-point(s) for predicting any problem use and any DSM-5 substance use disorder (SUD). Results Examining the CRAFFT as a continuous measure, AUC values were 0.93 for problem use or higher and 0.97 for DSM-5 SUD. Consistent with previously recommended cut-points for the CRAFFT, the cut-point of 2 performed optimally for identifying adolescents both exhibiting problem use of alcohol or drugs and meeting DSM-5 SUD criteria for alcohol or other drugs. Conclusions Despite changes in the DSM substance use diagnostic criteria, the CRAFFT continues to demonstrate excellent sensitivity and specificity at its established cut-point of 2. Additional studies examining the CRAFFT in light of the new DSM-5 diagnostic criteria with more diverse populations are warranted.

[1]  A. Knudsen,et al.  Psychometric properties and concurrent validity of the CRAFFT among Norwegian adolescents. Ung@hordaland, a population-based study. , 2013, Addictive behaviors.

[2]  K. Bucholz,et al.  DSM-5 criteria for substance use disorders: recommendations and rationale. , 2013, The American journal of psychiatry.

[3]  Li-Tzy Wu,et al.  Screening instruments for substance use and brief interventions targeting adolescents in primary care: a literature review. , 2013, Addictive behaviors.

[4]  P. Kokotailo,et al.  Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians , 2011, Pediatrics.

[5]  B. Zumbo,et al.  A review of the psychometric properties of the CRAFFT instrument: 1999-2010. , 2011, Current drug abuse reviews.

[6]  S. Chong,et al.  Validity of a brief screening instrument-CRAFFT in a multiethnic Asian population. , 2010, Addictive behaviors.

[7]  P. Kokotailo.  Alcohol Use by Youth and Adolescents: A Pediatric Concern , 2010, Pediatrics.

[8]  M. Behnke,et al.  Policy statement - Alcohol use by youth and adolescents , 2010 .

[9]  Robert L. Cook,et al.  Alcohol screening in young persons attending a sexually transmitted disease clinic , 2007, Journal of General Internal Medicine.

[10]  J. Kulig,et al.  Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention, Identification, and Management of Substance Abuse , 2005, Pediatrics.

[11]  S. Levy,et al.  Test-retest reliability of adolescents' self-report of substance use. , 2004, Alcoholism, clinical and experimental research.

[12]  D. Svikis,et al.  Selection of a substance use disorder diagnostic instrument by the National Drug Abuse Treatment Clinical Trials Network. , 2004, Journal of substance abuse treatment.

[13]  M. Larimer,et al.  Validity of the CRAFFT in American-Indian and Alaska-Native adolescents: screening for drug and alcohol risk. , 2003, Journal of studies on alcohol.

[14]  John R Knight,et al.  Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT. , 2003, Alcoholism, clinical and experimental research.

[15]  G. Chang,et al.  Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. , 2002, Archives of pediatrics & adolescent medicine.

[16]  J. Vander Bilt,et al.  A new brief screen for adolescent substance abuse. , 1999, Archives of pediatrics & adolescent medicine.

[17]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.