CRAFFT

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The CRAFFT Screening Interview

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“I’m going to ask you a few questions that I ask all my patients."

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Please be honest.

I will keep your answers confidential.

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1. During the PAST 12 MONTHS, did you: Drink any alcohol (more than a few sips)? (Do not count a few sips of alcohol taken during family or religious events)* This field is required.Question 1 of 9

YesNo

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During the PAST 12 MONTHS, did you: * This field is required.Question 2 of 9

YesNo

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During the PAST 12 MONTHS, did you: * This field is required.Question 3 of 9

YesNo

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Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?Question 4 of 9

YesNo

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Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?Question 5 of 9

YesNo

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Do you ever use alcohol or drugs while you are by yourself, or ALONE?Question 6 of 9

YesNo

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Do you ever FORGET things you did while using alcohol or drugs?Question 7 of 9

YesNo

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Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?Question 8 of 9

YesNo

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Have you ever gotten into TROUBLE while you were using alcohol or drugs?Question 9 of 9

YesNo

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If you would like to change any questions please click on the "Previous" bottom below on the left and if not click on "Submit"

CONFIDENTIALITY NOTICE:
The information recorded on this page may be protected by special federal confidentiality rules (42 CFR Part2), which prohibit disclosure of this information unless authorized by specific written consent. A general authorization for release of medical information is NOT sufficient for this purpose.