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Now let's say you're talking to an adolescent who's come into the ED after taking a handful of Vicodin pills. This patient also has a history of cutting herself, and so you need to assess whether or not this overdose was a suicide attempt and see if the patient is abusing any other substances.

You'll use the communication techniques we discussed earlier, and keeping in mind the SAFE-T framework, ask directly about the patient's situation. As you talk to her, keep in mind the warning signs for suicide risk we discussed earlier by using the IS PATH WARM mnemonic. If there's an indication that she may try to end her life or if she's showing signs of suicidal thinking, screen her using SAD PERSONS. Otherwise, screen her for substance abuse risk, continuing to monitor for any IS PATH WARM warning signs.

There's a substance-abuse screening toolkit that is appropriate for adolescents ages 14-21. It's called "Craft" (C.R.A.F.F.T.), a mnemonic acronym for six key topics covered in the screening. Each of the six topics indicates a greater risk for substance abuse and the negative consequences associated with it. CRAFFT helps determine if further substance abuse services or evaluations are needed, or if a brief intervention is warranted. Before you begin, tell patients to answer honestly.

Begin the CRAFFT screening by asking three questions: "In the past year did you…"

• Drink more than a few sips of alcohol?
• Smoke any marijuana or hashish?
• Or, use anything else to get high, including illegal drugs, over-the-counter and prescription drugs, or things that you may have sniffed or huffed?

If patients answer "yes" to any of these, you should ask about all six topics covered in the CRAFFT. If patients answer "no" to all three of the questions, you only need to ask about the first topic, C, for Car.