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For a substance abuse screening with adolescents ages 14-21, use the CRAFFT:

Tell patients to answer honestly and ask 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, ask about all six topics covered in the CRAFFT. If patients answer "no" to all three of the questions, you only need to ask topi C, for Car. Ask whether the patient…

C: CAR. Has been in a car when the driver (including themselves) was under the influence.
R: RELAX. Uses drugs or alcohol to deal with stress or pressures.
A: ALONE. Uses drugs or alcohol when they're alone versus with friends or at social gatherings.
F: FORGET. Can't remember things they did while using alcohol or drugs.
F: FRIEND. Has had family or friends express concern or told them to cut down.
T: TROUBLE. Has gotten in trouble as a result of using drugs or alcohol.

If the patient answers "No" to all six, she is no-risk. A patient who scores 0-1 but reports any use is low-risk and could benefit from a brief intervention. A patient who scores 2-6 is high risk and requires further services or assessment, and a brief intervention.

If you've identified a patient as low-risk following a CRAFFT screening, you'll need to:

• Determine an emergency plan by providing crisis line numbers and suggestions for adaptive coping strategies.
• Speak with the adolescent's' parent or guardian about implementing protective strategies, like having a support person available, and scheduling follow-up appointments with mental health professionals.
• Be aware of means restrictions (restricting access to means by which someone can carry out a suicidal act), especially those the patient has thought about using.