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

Abstract

Background: The CRAFFT, previously validated against DSM-IV 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 ages 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. We 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. We 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.

Validación empírica del CRAFFT Abuse Screening Test en una muestra de adolescentes españoles

“…es una de las herramientas más utilizadas para el screening del consumo de riesgo de alcohol y otras drogas en adolescentes (Mitchell et al, 2014). Tanto es así que su uso es recomendado por la guía "Alcohol Screening and Brief Intervention for Youth: Practicioner's Guide" (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2011) y por la American Academy of Pediatrics en su Policy Statement: "Substance use screening, brief intervention, and referral to treatment for pediatricians"(Committee on Substance Abuse, 2011).…”

The Usefulness of the CRAFFT in Screening for Problematic Drug and Alcohol Use Among Youth Living with HIV

“…Although multiple substance use screening tools have been validated for use with adults, recent meta-analytic work identifies only a few screening processes that have substantial empirical support for use with adolescents (15). The first is the Alcohol Use Disorders Identification Test (AUDIT), which screens for hazardous alcohol use, and the second is the Drug Use Disorders Identification Test (DUDIT), which screens for drug-related problems.…”

Usefulness of the CRAFFT to Diagnose Alcohol or Cannabis Use Disorders in a Sample of Emerging Adults with Past-Month Alcohol or Cannabis Use

“…A recent study found that a cut-off of 2 continues to be sensitive and specific for identifying drug and alcohol use disorders using DSM-V criteria in 14–18 year olds. (Mitchell et al, 2014) Two other ‘second level’ screener studies of 18–20 year-olds seeking emergency room care and admitting to recent alcohol use found the CRAFFT had 94–95% sensitivity and 44–49% specificity, using the cut-off score of 2, for diagnosing an alcohol use disorder based on the DSM-IV definitions of abuse and dependence,(Kelly et al, 2009; Kelly et al, 2004) but these studies did not report test characteristics for cannabis use.…”