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The Usefulness of the CRAFFT in Screening for Problematic Drug and Alcohol Use Among Youth Living with HIV

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Abstract

Substance use is highly prevalent among youth living with HIV (YLWH) and negatively impacts HIV care. This study sought to determine whether the CRAFFT (Car, Relax, Alone, Forget, Friends, and Trouble), designed to screen for problematic substance use, is reliably associated with substance use behaviors among YLWH. A cross-sectional sample of 2216 youth (ages 12–26) were recruited through the adolescent medicine trials network for HIV/AIDS Interventions. Participants completed a self-administered survey. Over half screened positive on the CRAFFT (i.e., ≥2). Among frequent substance users, those older in age, behaviorally infected, with history of incarceration or unstably housed were more likely to screen positive on the CRAFFT. Study findings suggest that the CRAFFT reliably identifies youth who use substances. Thus, screening measures such as the CRAFFT should be utilized routinely in HIV clinical settings for youth.

Resumen

El uso de sustancias entre jóvenes que viven con el VIH es muy prevalente y afecta negativamente el cuidado del VIH. Este estudio trató de determinar si el CRAFFT, una prueba diseñada para detectar el uso problemático de sustancias, se asocia con fiabilidad con comportamientos de consumo de sustancias entre los jóvenes que viven con el VIH. Una muestra transversal de 2216 jóvenes (edades 12–26) fueron reclutados a través del Adolescent Medicine Trials Network para Intervenciones contra el VIH/SIDA. Los participantes completaron una encuesta autoadministrada. Más de la mitad fueron seleccionados como positivos por el CRAFFT (es decir, ≥2). Entre los usuarios frecuentes de sustancias, los mayores de edad, los infectados por conducta en comparación con aquellos infectados perinatalmente, y aquellos con antecedentes de encarcelamiento y viviendas inestables fueron más propensos a resultados positivos en el CRAFFT. Los hallazgos del estudio sugieren que el CRAFFT identifica de manera fiable a los jóvenes que usan sustancias. Por lo tanto, pruebas como el CRAFFT deben utilizarse de forma rutinaria en contextos clínicos de VIH para los jóvenes.

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References

  1. HIV Surveillance Report. 2014. http://www.cdc.gov/hiv/library/reports/surveillance/. Accessed 22 Mar 2016.

  2. Johnston LD, O’Malley P, Bachman JG, Schulenberg JE. Monitoring the future national results on adolescent drug use: overview of key findings, 2011. Ann Arbor: Institute for Social Research, The University of Michigan; 2012.

    Google Scholar 

  3. Volkow ND, Montaner J. Enhanced HIV testing, treatment, and support for HIV-infected substance users. J Am Med Assoc. 2010;303(14):1423–4.

    Article  CAS  Google Scholar 

  4. Kalichman SC, Amaral CM, White D, et al. Prevalence and clinical implications of interactive toxicity beliefs regarding mixing alcohol and antiretroviral therapies among people living with HIV. AIDS Patient Care STDs. 2009;23(6):449–54.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Steinberg L. A social neuroscience perspective on adolescent risk-taking. Dev Rev. 2008;28:78–106.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Somerville LH, Jones RM, Casey BJ. A time of change: behavioral and neural correlates of adolescent sensitivity to appetitive and aversive environmental cues. Brain Cogn. 2010;72(1):124–33.

    Article  PubMed  Google Scholar 

  7. Webb MS, Vanable PA, Carey MP, Blair DC. Cigarette smoking among HIV + men and women: examing health, substance use, and psychosocial correlates across the smoking spectrum. J Behav Med. 2007;30(5):371–83.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lifson AR, Lando HA. Smoking and HIV: prevalence, health risks, and cessation strategies. Curr HIV/AIDS Rep. 2012;9(3):223–30.

    Article  PubMed  Google Scholar 

  9. Swahn MH, Bossarte RM, Ashby JS, Meyers J. Pre-teen alcohol use initiation and suicide attempts among middle and high school students: findings from the 2006 Georgia Student Health Survey. Addict Behav. 2010;35:452–8.

    Article  PubMed  Google Scholar 

  10. Mimiaga MJ, Biello K, Reisner SL, et al. Latent class profiles of internalizing and externalizing psychosocial health indicators are differentially associated with sexual transmission risk: findings from the CFAR Network of Integrated Clinic Systems (CNICS) cohort study of HIV-infected men engaged in in primary care in the United States. Health Psychol. 2015;34(9):951–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. U.S. Preventive Service Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendations statement. Ann Intern Med. 2004;140(7):554–6.

    Article  Google Scholar 

  12. Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions. Referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99(1–3):280–95.

    Article  PubMed  Google Scholar 

  13. Surah S, Kieran J, O’Dea S, et al. Use of the alcohol use identification test (AUDIT) to determine the prevalence of alcohol misuse among HIV-infected individuals. Int J STDs AIDS. 2013;24(7):517–21.

    Article  CAS  Google Scholar 

  14. Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med. 2002;156:607–61.

    Article  PubMed  Google Scholar 

  15. Mitchell SG, Kelly SM, Gryczynski J, et al. The CRAFFT cut-points and DSM-5 criteria for alcohol and other drugs: a re-evaluation and re-examination. Subst Abus. 2014;35(4):376–80.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chung T, Colby SM, Barnett NP, Rohsenow DJ, Spirito A, Monti PM. Screening adolescents for problem drinking: performance of brief screens against DSM-IV alcohol diagnoses. J Stud Alcohol. 2000;61(14):579–87.

    Article  CAS  PubMed  Google Scholar 

  17. Knight JR, Sherritt L, Harris SK, Gates EC, Chang G. Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT. Alcohol Clin Exp Res. 2003;27(1):67–73.

    Article  PubMed  Google Scholar 

  18. MacDonell KM, Jacques-Tiura AJ, Naar S, Fernandez MI, Team AP. Predictors of self-reported adherence to antiretroviral medication in a multiside study of ethnic and racial minority HIV-positive youth. J Pediatr Psychol. 2015;41:419–28.

    Article  PubMed  Google Scholar 

  19. Tanney MR, Naar-King S, MacDonell KM. Depression and stigma in high-risk youth living with HIV: a multi-site study. J Pediatr Health Care. 2012;26(4):300–5.

    Article  PubMed  Google Scholar 

  20. Fernandez MI, Huszti HC, Wilson PA, Kahana SY, Nichols SL, Gonin R, Xu J, Kapogiannis BG. Profiles of risk among HIV-infected youth in clinic settings. AIDS Behav. 2015;19(5):918–30.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kahana SY, Jenkins RA, Bruce D, Fernandez MI, Hightow-Weidman LB, Bauermeister JA, Interventions AMTNfHA. Structural determinents of antireteroviral therapy use, HIV care attendance, and viral suppression among adolescents and young adults living with HIV. PLoS ONE. 2016;11(4):e0151106.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Knight JR, Shrier LA, Bravender TD, Farrell M, Van Bilt J, Shaffer HJ. A new brief screen for adolescent substance abuse. Arch Pediatr Adolesc Med. 1999;153(6):591–6.

    Article  CAS  PubMed  Google Scholar 

  23. World Health Organization. The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction. 2002;97:1183–94.

    Article  Google Scholar 

  24. Dawson-Rose C, Draughon JE, Zepf R, Cuca YP, Huang E, Freeborn K, Lum PJ. Prevalence of substance use in HIV primary care safety net clinics: a call for screening. J Assoc NursE AIDS Care. 2015;. doi:10.1016/j.jana.2015.12.001.

    Google Scholar 

  25. Mimiaga MJ, Reisner SL, Grasso C, Crane HM, Safren SA, Kitahata MM, Schumacher JE, Matthews WC, Mayer KH. Substance use among HIV-infected patients engaged in primary care in the United States: findings from the Centers for AIDS Research Network of Integrated Clinic Systems Cohort. Am J Public Health. 2013;103(8):1457–67.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Nichols SL, Lowe A, Zhang X, Garvie PA, Thorton S, Golderberger BA, Hou W, Goodenow MM, Sleasman JW. Concordance between self-report substance use and toxicology among HIV-infected and uninfected at risk youth. Drug Alcohol Depend. 2014;134:376–82.

    Article  CAS  PubMed  Google Scholar 

  27. Rasmussen LD, Helleberg M, May MT, Afzal S, Kronborg G, Larsen CS, et al. Mycocardial infraction among Danish HIV-infected individuals: population-attributable fractions associated with smoking. Clin Infect Dis. 2015;60(9):1415–23.

    PubMed  Google Scholar 

  28. Helleberg M, May MT, Ingle SM, Dabes F, Reiss P, Fatkenheuer G, et al. Smoking and life expectancy among HIV-infected individual on antiretroviral therapy in Europe and North America. AIDS. 2015;29(2):221–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Grant JD, Verges A, Jackson KM, Trull TJ, Sher KJ, Bucholtz KK. Age and ethnic differences in the onset, persistence and recurrence of alcohol use disorder. Addiction. 2012;107:756–65.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Crosby RA, DiClemente RJ, Wingood GM, Rose E, Levine D. Adjudication history and African American adolescents’ risk for acquiring sexually transmitted diseases: an exploratory analysis. Sex Transm Dis. 2003;30(8):634–8.

    Article  PubMed  Google Scholar 

  31. Tolou-Shams M, Brown LK, Gordon G, Fernandez I, Project SHIELD Study Group. Arrest history as an indicator of adolescent/young adult substance use and HIV risk. Drug Alcohol Depend. 2007;88(1):87–90.

    Article  PubMed  Google Scholar 

  32. Omura JD, Wood E, Nguyen P, Kerr T, DeBeck K. Incarceration among street-involved youth in a Canadian study: implication for health and policy interventions. Int J Drug Policy. 2014;25(2):291–6.

    Article  PubMed  Google Scholar 

  33. Babor TF, Kranzler HR, Lauerman RJ. Early detection of harmful alcohol consumption: comparison of clinical, laboratory, and self-report screening procedures. Addict Behav. 1989;14:139–57.

    Article  CAS  PubMed  Google Scholar 

  34. Winters KS, Stinchfield RD, Henly GA, Schwartz RH. Validity of adolescent self-report of alcohol and other drug involvement. Int J Addict. 1990;25:1379–95.

    Article  PubMed  Google Scholar 

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Acknowledgements

The investigators are grateful to the members of the local youth Community Advisory Boards for their insight and counsel and are particularly indebted to the youth who participated in this study. The comments and views of the authors do not necessarily represent the views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Funding

This work was supported by The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) from the National Institutes of Health (U01 HD 040533 and U01 HD 040474) through the National Institute of Child Health and Human Development (Lee Kapogiannis), with supplemental funding from the National Institutes on Drug Abuse (Kahana Davenny) and Mental Health (Allison Brouwers). Support was also provided to the first, second, and third by the Lifespan/Tufts/Brown Center for AIDS Research (P30AI042853, PI: C. Carpenter) to the first author by (T32MH078788, PI: L. Brown; U24AA022000, PI: Operario), and to the second author by career development grant (K23MH109346, PI: K. Nelson). The study was scientifically reviewed by the ATN’s Behavioral Leadership Group. Network, scientific and logistical support was provided by the ATN Coordinating Center (Partlow Wilson) at The University of Alabama at Birmingham. Network operations and data management support was provided by the ATN Data and Operations Center at Westat, Inc. (Driver Korelitz).We acknowledge the contribution of the investigators and staff at the following sites that participated in this study: University of South Florida, Tampa (Emmanuel, Lujan-Zilbermann, Julian), Children’s Hospital of Los Angeles (Belzer, Flores, Tucker), Children’s National Medical Center (D’Angelo, Hagler, Trexler), Children’s Hospital of Philadelphia (Douglas, Tanney, DiBenedetto), John H. Stroger Jr. Hospital of Cook County and the Ruth M. Rothstein CORE Center (Martinez, Bojan, Jackson), University of Puerto Rico (Febo, Ayala-Flores, Fuentes-Gomez), Montefiore Medical Center (Futterman, Enriquez-Bruce, Campos), Mount Sinai Medical Center (Steever, Geiger), University of California-San Francisco (Moscicki, Auerswald, Irish), Tulane University Health Sciences Center (Abdalian, Kozina, Baker), University of Maryland (Peralta, Gorle), University of Miami School of Medicine (Friedman, Maturo, Major-Wilson), Children’s Diagnostic and Treatment Center (Puga, Leonard, Inman), St. Jude’s Children’s Research Hospital (Flynn, Dillard), Children’s Memorial Hospital (Garofalo, Brennan, Flanagan), Baylor College of Medicine (Paul, Calles, Cooper), Wayne State University (Secord, Cromer, Green-Jones), John Hopkins University School of Medicine (Agwu, Anderson, Park), The Fenway Institute–Boston (Mayer, George, Dormitzer), University of Colorado Denver (Reirden, Hahn, Witte).

Author information

Authors and Affiliations

  1. Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02129, USA

    Kristi E. Gamarel

  2. Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02129, USA

    Kristi E. Gamarel

  3. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA

    Kimberly M. Nelson & Larry Brown

  4. Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, USA

    Kimberly M. Nelson

  5. Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA

    Larry Brown

  6. College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA

    M. Isabel Fernandez

  7. Department of Neurosciences, University of California, San Diego, CA, USA

    Sharon Nichols

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  1. Kristi E. Gamarel
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  4. M. Isabel Fernandez
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  5. Sharon Nichols
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The Adolescent Medicine Trials Network for HIV/AIDS Intervention

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Correspondence to Kristi E. Gamarel.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Gamarel, K.E., Nelson, K.M., Brown, L. et al. The Usefulness of the CRAFFT in Screening for Problematic Drug and Alcohol Use Among Youth Living with HIV. AIDS Behav 21, 1868–1877 (2017). https://doi.org/10.1007/s10461-016-1640-2

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  • DOI: https://doi.org/10.1007/s10461-016-1640-2

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