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 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.

Keywords:

• Adolescent
• substance use
• screening
• CRAFFT
• DSM-5

FUNDING

Research reported in this publication was supported by the National Institute on Drug Abuse (NIDA) R01DA026003–03S1 (Principal Investigator: Schwartz). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIDA or the National Institutes of Health.

AUTHOR CONTRIBUTIONS

Mitchell, Kelly, Gryczynski, O’Grady, and Schwartz contributed to the conceptualization of the study, the writing of the research protocol, and all phases of manuscript preparation. Myers, Gryczynski, Kelly, and O’Grady assisted with data analysis and interpretation of results. Kirk assisted in the conceptualization of the study and reviewed and edited the manuscript. All authors assisted with manuscript revisions and approved the final manuscript as submitted.