Michigan Alcohol Screening Test

The Michigan Alcohol Screening Test (MAST) is a patient self-report alcoholism screening measure. The items ask individuals about a range of alcohol-related problems (e.g., Item 10: Have you gotten into fights when drinking?), the extent to which they have had diminished control over drinking (e.g., Item 4: Can you stop drinking without a struggle after one or two drinks?), and symptoms of alcohol tolerance and withdrawal (e.g., Item 19: Have you ever had delirium tremens [DTs], severe shaking, heard voices, or seen things that weren't there after heavy drinking?). Consistently, the MAST has been shown to perform well in identifying individuals who have abused alcohol or been dependent on it.

The MAST contains 25 yes or no questions that are differentially weighted. Individuals complete the MAST individually as a questionnaire or in an interview format. The measure yields an overall score ranging from 0 to 53 by summing individual items as follows: no answers get a score of 0, and yes answers get a score of 1, 2, or 5 depending on the inherent severity of the symptom covered in the item. The recommended interpretation of the total score is for 0 to 4 to indicate absence of alcoholism, 5 to 6 to suggest [Page 547]possible alcoholism, and 7 or more to indicate probable alcoholism. Symptoms included in the MAST are not explicitly linked to any standard diagnostic criteria for alcohol use disorders.

It takes approximately 5 minutes to administer the MAST and 2 minutes to score it. It can be scored by the administrator or by computer. No special training is required for administration. Several briefer versions of the MAST also are available. These tests include the 13-item Short MAST (SMAST), the 10-item Brief MAST, and a geriatric version called the MAST-G. All of these instruments are in the public domain and do not require permission for use.

The MAST scores have been shown to be consistent when re-administered to the same individuals over brief periods (1-day to 1-week intervals) and several months, demonstrating that the scale is reliable. The MAST also has been shown to accurately detect alcohol use disorders when checked against clinician-interview diagnoses. Different cutoff scores have been examined to yield the best combination of correctly distinguishing individuals with true alcohol use disorders from those persons who do not have drinking problems. Cutoff scores between 5 and 15 have been recommended. The MAST scores also have been shown to correspond with other measures of alcohol use severity. Notably, the originator of the MAST, Melvin Selzer, found that the 13-item SMAST was as effective as the MAST in screening for alcoholism. SMAST scores of 0 to 1 suggest no problems with alcoholism. SMAST scores of 2 point to possible alcohol use problems. SMAST scores of 3 or higher are likely to meet criteria for alcohol abuse or dependence. Selzer concluded that when time is limited, the SMAST may be substituted for the MAST.

The strengths of the MAST include that it can be administered reliably in a variety of clinical and non-clinical settings, including when used in psychiatric settings. It also provides a gross, general measure of lifetime problem severity that can be used for choosing treatment intensity and guiding further inquiry into alcohol-related problems. Because the items do not specify a time frame, however, the scale does not distinguish between current and past alcohol problems and, therefore, is not useful as a change measure. It also does not assess drinking frequency and quantity. Furthermore, because the focus is typically on late-stage symptoms of alcoholism, it may miss less severe use or patterns of use that occur earlier in the course of the illness and thus not perform as well as a screening measure in populations where drinking patterns may vary more widely (e.g., college students). Finally, because the intent of the MAST questions is straightforward, individuals may easily disguise actual problems related to their lifetime history of drinking.

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