Statewide Administration of the CRAFFT Screening Tool: Highlighting the Spectrum of Substance Use

Abstract

Background: Adolescent alcohol and drug use in the United States are associated with negative consequences spanning multiple domains. Much of the public health surveillance of these behaviors relies on self-report survey data. These data frequently takes the form of frequency or prevalence data for specific substances, which may not provide a complete picture of use. Objectives: This study analyzes a state-level survey that includes the CRAFFT screening tool. The study's goal is to elucidate the spectrum of substance use severity across a large segment of substance-using adolescents attending schools in the state of Indiana and to assess the contribution of a variety of predictor variables to the variance between users falling into each category of use severity. Methods: Data were collected in 2011 from 168,801 adolescents, of whom 25,204 met the inclusion criteria for this study. The authors utilize multinomial logit analyses to highlight variables, including sociodemographic data, poly-drug use, and risk/protective behavior scales, associated with each category of use. Results: Seriousness of use is not uniform across substance-using adolescents; 49% were categorized as nonproblem users, 33% as problem users, and 18% as dependent users. Risk and protective factors predict adolescents’ severity of substance use, but do not do so uniformly. Poly-drug use is a significant predictor of problem use and dependent use as well. Conclusions: The CRAFFT may provide a more nuanced perspective of adolescent substance use than frequency/prevalence data alone; the authors describe the implications derived from these data and analyses to the adolescent prevention and treatment systems.

• Keywords screening
• CRAFFT
• data collection
• prevention
• adolescent
• treatment

THE AUTHORS

Jon Agley, PhD, MPH, is an assistant research scientist at both the Indiana Prevention Resource Center and the Institute for Research on Addictive Behavior in the School of Public Health, Indiana University, Bloomington. His scientific research focus is screening, brief intervention, and referral to treatment (SBIRT) for alcohol and substance use.

Ruth A. Gassman, PhD, is the Executive Director of both the Indiana Prevention Resource Center and the Institute for Research on Addictive Behavior in the School of Public Health, Indiana University, Bloomington. Her scientific focus is alcohol and drug health services research.

Mikyoung Jun, PhD, MPH, MS, MCHES, is a survey statistician and research associate at the Indiana Prevention Resource Center in the School of Public Health, Indiana University, Bloomington. She serves as the primary data analyst for the Indiana Youth Survey and the Indiana College Substance Use Survey.

Carole Nowicke, PhD, MLS, is a reference specialist and research associate at the Indiana Prevention Resource Center and the Institute for Research on Addictive Behavior in the School of Public Health, Bloomington, Indiana. In addition to her work as a reference specialist she actively researches American cultural history and oral tradition.

Susan Samuel, MSc, MS, is a research associate at the Indiana Prevention Resource Center in the School of Public Health, Indiana University, Bloomington. She serves as the coordinator for the Indiana Youth Survey.

GLOSSARY

Continuum of substance use: in this paper, refers to a spectrum of use of substances ranging from nonuse, nonproblem use, problem use, and dependent use—rather than a simpler binary (use/nonuse) paradigm.

CRAFFT: a screening tool designed to be completed by adolescents that can be used to identify problem use and dependent use.

Risk and protective factors: In this paper, risk and protective factors refer specifically to scales from the Communities that Care Youth Survey. Adolescents exhibiting a given risk factor are at higher risk of using substances relative than their nonrisk peers, whereas adolescents exhibiting a given protective factor are at lower risk of using substances relative than their nonprotected peers.