Pediatricians should ask teens about drug, alcohol use at every visit


Former Executive Editor, Harvard Health

At almost every doctor visit, adolescents have their blood pressure checked. But few are asked about their use of alcohol and drugs, which contribute to the leading causes of injury and death in this age group.

To make it easier for doctors and nurses talk with teens about alcohol and drugs, the American Academy of Pediatrics has just published a set of questions to guide the conversation, along with advice on what to do with the answers.

“Talking with adolescents about drugs and alcohol should be a brief, easy part of every health care visit,” Dr. Sharon J.L. Levy, director of the Adolescent Substance Abuse Program at Children’s Hospital Boston and a lead author of the paper, told me.

The conversation should also be confidential. “Once a child reaches adolescence, a parent should expect, even encourage, the pediatrician to have a private, one-on-one conversation with the teen,” said Dr. Levy, who is also an assistant professor of pediatrics at Harvard Medical School.

Asking the right questions

The report recommends that pediatricians and other health-care providers follow a two-step script. First, ask the teen if he or she has drunk alcohol, smoked marijuana or hashish, or used anything else to get high. If the answer is no, the health care provider should praise the teen and encourage him or her to continue making good decisions about health and safety.

If the teen says yes to drinking alcohol or using drugs, asking the six CRAFFT questions can help separate those who are experimenting from those who may be headed for serious trouble and need more in-depth help. If there is a clear risk to health, the clinician should involve a parent.

Adolescence is a vulnerable period for the adolescent and the adolescent brain. “The earlier a boy or girl begins drinking or using drugs, the greater the likelihood of later substance abuse,” said Dr. Levy. “The sooner we can identify at-risk youths, the better our chances of helping them.”

While a conversation with a doctor or nurse is important, parents need to be covering the same ground. If you don’t know where to start, here are links to helpful guides on talking with teens about alcohol and drugs.)

These conversations aren’t always easy, as I know all too well from experience with my three teenagers. But if they can help my teens, or their friends, it is well worth the effort.

CRAFFT questions


Here are the six CRAFFT questions:

C = Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?

R = Do you ever use drugs or alcohol to RELAX, feel better about yourself, or fit in a bit?

A = Do you ever use drugs or alcohol while you are by yourself, or ALONE?

F = Do you ever FORGET things you did while using alcohol or drugs?

F = Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?

T = Have you ever gotten into TROUBLE while you were using alcohol or drugs?

According the American Academy of Pediatrics, zero or one yes to the CRAFFT questions should elicit nonjudgmental, nonpreachy advice, such as “I recommend that you stop drinking (or doing drugs) and now is the best time. Alcohol (or drugs) kill brain cells and can make you do stupid things that you will regret. You are such a good student (or friend, athlete). I would hate to see anything interfere with your future.” Two or more yesses should prompt an in-depth discussion about alcohol and drug use.

The CRAFFT questionnaire was developed by the Center for Adolescent Substance Abuse Research at Children’s Hospital Boston.


  1. Sara Snow

    Letting your child know that their conversation with their physician is confidential and ensuring they truly understand and believe that is a critical step towards increasing the odds they’ll feel comfortable sharing substance use/abuse issues or answering questions on the matter.

    I recently published an article on dealing with teenage alcoholism that’s applicable to most any minor age bracket. Look for the signs, understand how to formulate an approach that won’t have an adverse reaction, and weigh all available treatment options.

  2. baby cots

    I totally agree.

  3. Beating Addiction

    Great,awesome and very informative.I have liked the way you have explained in details.Thanks.

  4. Heather Smith

    Informative post, CRAFFT Questionnaire is a good guidelines for doctors or any medical practitioners in asking teens about drugs and alcohol use.Thanks again for posting.

  5. Anonymous

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  6. EP Registered Nurse

    Good post. Very informative indeed.

  7. Anna

    Great post! As a nurse and aunt to several teenagers, I appreciate this a bunch!

    – Anna, RN and Bloggger

  8. Anonymous

    Teenagers should always be reminded about the right perspectives on alcohol and drug use. Constant education to teenagers at home, in school, in hospitals or in any other place should be pushed through.
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  9. Anonymous

    Yes this is necessary for the health of youngsters because now a days lots of teenagers take alcohol, smoking and many kinds of drugs. It all are bad for their health so its doctor’s duty that aware to teens from these bad habits.

  10. Anonymous

    You made some clear points there. I did a search on the subject matter and found most people will agree with your blog. The conversation should also be confidential. “Once a child reaches adolescence, a parent should expect, even encourage, the pediatrician to have a private, one-on-one conversation with the teen. You wrote about many interesting points in this post. I really enjoyed this. It is great tips and helpful guideline for use. Thanks for sharing.
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