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Research Summary

Prevalence of Adolescent Substance Use Identified by Screening in Primary Care

Screening for alcohol and drug use among adolescents is advocated by the American Medical Association and others. However, the prevalence of adolescent substance use problems and disorders identified with an accepted screening instrument is not known.

Using the validated CRAFFT* instrument, researchers screened 2133 12- to 18-year olds (representing a 93% participation rate) from a network of various New England primary care practices. Researchers determined the prevalence of positive screening results (2 or more positive responses, which is highly correlated with having a substance-related diagnosis and needing treatment) in the overall sample, by visit type (e.g., well-child care, sick visit), and by practice site (urban hospital-based clinics, health maintenance organizations, rural family-medicine practices, and school-based health centers).

  • Overall, 44% of subjects reported any lifetime use of alcohol or other drugs.
  • Fifteen percent screened positive on the CRAFFT, with the highest prevalence of positive screens in school-based clinics (30%) and rural family practices (24%).
  • The prevalence of positive screens was lower at well-child visits (11%) than at sick visits (23%).
  • Statistical modeling estimated that 22% of the adolescents had nonproblematic use, 11% had problematic use (>1 substance-related problem during the past year but no diagnosis of abuse or dependence), 7% had abuse, and 3% had dependence.


The prevalence of substance use problems among adolescents, as determined with a validated tool in primary care settings, is high. Therefore, identifying and implementing efficacious approaches to address these problems is essential. 

Jeffrey H. Samet, MD, MA, MPH

*Car Relax Alone Forget Friends Trouble (the main words in 5 separate questions about alcohol and drug use)


Knight JR, Harris SK, Sherritt L, et al. Prevalence of positive substance abuse screen results among adolescent primary care patients. Arch Pediatr Adolesc Med. 2007;161(11):1035–1041.