A Review of the Psychometric Properties of the CRAFFT Instrument: 1999-2010

Introduction: Alcohol (AUD) and other substance use disorders (SUD) are common among adolescents. The CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble, 1999) was developed as a brief screening instrument for adolescents to measure AUD and SUD. This systematic review examines the psychometric properties of the CRAFFT.

Methods: We performed a systematic review using Cochrane Database for Systematic Reviews, Pubmed/Medline, Embase (1980 to present), PsycInfo, and Google Scholar using the keywords "CRAFFT", "CRAFFT questionnaire", "alcohol misuse", "alcohol abuse", "alcohol dependence" "alcohol", "substance misuse", and "substance abuse" and "substance dependence".

Results: We report 11 studies on validity and six studies on reliability. Populations examined were clinic patients including hospital-based clinic patients, primary care patients, emergency room patients, Native-Americans, sexually transmitted diseases clinic patients, substance users, a general population group, and enlisting military concripts. In general, the CRAFFT was found to be a good screening instrument for gradations of alcohol and substance misuse including problem use, abuse, and dependence. At optimal cut-points, sensitivities of the CRAFFT ranged from 0.61 to 1.00, and specificities ranged from 0.33 to 0.97. The CRAFFT showed modest to adequate internal consistency values ranging from 0.65 to 0.86, and high test-retest reliability.

Conclusion: The CRAFFT has adequate psychometric properties for detecting AUD and SUD in adolescents. However, more studies of the psychometric properties of the CRAFFT need to be carried out to further assess and improve generalizability to other populations. Gender and ethnic differences also require further examination, as do versions that are adapted for different languages and cultures.