CRAFFT PHQ Storybook Patients

CRAFFT & PHQ Forms (to be completed by Patient and NOT Parent)


During the PAST 12 MONTHS, on how many days did you:

Please answer the following also.

4. Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
5. Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
6. Do you ever use alcohol or drugs while you are by yourself, or ALONE?
7. Do you ever FORGET things you did while using alcohol or drugs?
8. Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
9. Have you ever gotten into TROUBLE while you were using alcohol or drugs?

PHQ-9 Form

Over the last 2 weeks, how often have you been bothered by any of the following problems?

1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead or of hurting yourself in some way
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?