A Review of the Psychometric Properties of the CRAFFT Instrument: 1999-2010 Shayesta Dhalla*,1, Bruno D. Zumbo2 and Gary Poole3
University of British Columbia, Vancouver, Canada
Department of Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, Canada School of Population and Public Health, University of British Columbia, Vancouver, Canada Abstract: 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.
Keywords: CRAFFT, screening, alcohol, substance, psychometric. INTRODUCTION Alcohol consumption among adolescents is a worldwide phenomenon on the increase . The WHO Global Survey on Alcohol and Health (2008) reported an increasing fiveyear trend in drinking among adolescents and young adults. In the UK, Ireland, Denmark, and increasingly Australia, young people drink more alcohol than those in the USA, France, and other Mediterranean countries . In the WHO Global Survey on Alcohol and Health (2008), the five-year trend of under-age drinking was assessed: out of 73 responding countries, 71% indicated an increase, 4% a decrease, 8% were stable and 16% showed inconclusive trends . The survey included the following regions: Africa, the Americas, South-east Asia, Europe, Eastern Mediterranean regions, and the Western Pacific regions. Further information on alcohol and substance use in individual countries is also reported in this survey . “Problem use” has been defined as more than one substance-related negative consequence (e.g., accident, *Address correspondence to this author at the University of British Columbia, 214-5550 Cambie Street, Vancouver, British Columbia, V5Z 3A2, Canada; Tel: (604)–321-4116; E-mail: firstname.lastname@example.org
injury, school failure) during the past year, but with no diagnosis of abuse or dependence [4, 5]. Alcohol and other substance abuse is characterized by continued use despite harm and dependence, preoccupation with use, and tolerance and/or withdrawal symptoms . Recent research in the US mentions that an early age of drinking corresponds to an increased likelihood of developing alcohol dependence . The most recent...