CRAFFT

                                                                                                                  Yes              No

1. Have you ever ridden in a Car driven by someone                           ______        ______
    (including yourself) who was high or had been using
    Alcohol or drugs?

2. Do you ever use alcohol or drugs to Relax, feel better                     ______        ______
    about yourself, or fit in?

3. Do you ever use alcohol or drugs while you are by                          ______        ______
    yourself Alone?

4. Do you ever Forget things you did while using alcohol                    ______        ______
    or drugs?

 5. Do your Family or Friends ever tell you that you should                ______       ______
     cut down on your drinking or drug abuse?

6. Have you ever gotten into Trouble while you were using                 ______        ______
    alcohol or drugs?

Scoring: 2 or more positive items indicate the need for further assessment.