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CRAFFT Self Administer

CRAFFT Self Administer - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires



NOTICE TO CLINIC STAFF AND MEDICAL RECORDS:
The information on this page may be protected by special federal confidentiality rules (42 CFR Part 2), which prohibit disclosure of this information
unless authorized by specific written consent. A general authorization for release of medical information is NOT sufficient.


© Children’s Hospital Boston, 2011.
Reproduced with permission from the Center for Adolescent Substance Abuse Research, CeASAR, Children’s Hospital Boston.
CRAFFT Reproduction produced with support from the Massachusetts Behavioral Health Partnership.


The CRAFFT Screening Questionnaire
Please answer all questions honestly; your answers will be kept confidential.




Part A
During the PAST 12 MONTHS, did you: No Yes
1. Drink any alcohol (more than a few sips)?
 
2. Smoke any marijuana or hashish?
 
3. Use anything else to get high?
 
(“anything else” includes illegal drugs, over the counter
and prescription drugs, and things that you sniff or “huff”)




Part B No Yes
1. Have you ever ridden in a CAR driven by someone
(including yourself) who was “high” or had been
using alcohol or drugs?



2. Do you ever use alcohol or drugs to RELAX, feel
better about yourself, or fit in?
 
3. Do you ever use alcohol or drugs while you are by
yourself, or ALONE?
 
4. Do you ever FORGET things you did while using
alcohol or drugs?
 
5. Do your FAMILY or FRIENDS ever tell you that you
should cut down on your drinking or drug use?
 
6. Have you ever gotten into TROUBLE while you were
using alcohol or drugs?
 














If you
answered
YES to ANY
(A1, A2, A3),
answer
B1 to B6
below.
If you
answered
NO to ALL
(A1, A2, A3)
answer
only B1
below, then
STOP.