MAST (Michigan Alcohol Screening Test)
25-item validated yes/no screening tool for alcohol use disorder with weighted scoring. Score 0–53; ≥5 indicates probable alcoholism. Public domain. Selzer (1971).
MAST Score Interpreter
Score 5–6: probable alcohol use disorder indicated. Further diagnostic evaluation is warranted.
25 weighted yes/no items covering lifetime alcohol-related behaviours and consequences. Most items score 1 point for 'Yes'; some items are reverse-scored or weighted higher. Higher scores indicate more indicators of alcohol-related problems.
| Total score | Interpretation |
|---|---|
| 7+ | Definitive indicatorsScore ≥7: consistent with definitive indicators of alcohol dependence. Referral to treatment evaluation strongly recommended. |
| 5–6 | Probable alcohol use disorderScore 5–6: probable alcohol use disorder indicated. Further diagnostic evaluation is warranted. |
| 4–4 | SuggestiveScore of 4: suggestive of an alcohol problem. Further inquiry is recommended. |
| 0–3 | No problem indicatedScore 0–3: no significant alcohol problem indicated by this screen. |
Band structure per Selzer (1971). Optimal cutpoints vary by population and criterion; Ross et al. (1990) found 12/13 optimal against DSM-III criteria. Clinical convention — educational reference only, not a diagnostic tool.
Foundational Context
The Michigan Alcohol Screening Test (MAST) was developed by Melvin Selzer in 1971. It is one of the oldest and most widely cited alcohol screening tools, designed to identify alcohol use disorder (alcoholism) through a standardized series of questions covering drinking behaviors and consequences.
The MAST remains a reference standard in clinical practice, occupational health, and research. Its weighted scoring system makes it particularly sensitive to severe indicators of alcohol dependence.
What the Assessment Measures
The MAST evaluates alcohol-related problems across multiple domains, including social, interpersonal, occupational, legal, and medical consequences.
Items are answered Yes or No. Responses are weighted based on clinical significance:
- Most items score 1 point for "Yes."
- Some items are weighted 2 or 5 points (e.g., AA attendance = 5 points).
- Some items (1, 4, 6, 7) are scored for "No" (1–2 points).
Total score range: 0–53.
Interpretation Guidelines
- 0–3: No alcohol problem indicated.
- 4: Suggestive of an alcohol problem; further inquiry recommended.
- 5–6: Probable alcoholism; further diagnostic evaluation indicated.
- ≥7: Definitive alcoholism; referral to treatment strongly recommended.
Clinical Threshold: ≥5 is the standard cutoff for probable alcoholism.
Administration Considerations
- Lifetime Perspective: Items cover the patient's entire lifetime history, not just recent use.
- Scoring: Requires applying specific weights to each item. Automated scoring is highly recommended to avoid manual errors.
- Short Form: The SMAST (13 items) is a validated alternative for settings requiring brevity (positive screen threshold ≥3).
- Geriatrics: For adults over 65, the MAST-G is better validated and includes age-appropriate items.
Psychometric Properties
- Reliability: Good internal consistency (α ≈ 0.83–0.95).
- Validity: High sensitivity and specificity for DSM-defined alcohol use disorder. Strong correlation with structured diagnostic interviews.
Limitations
- Lifetime Focus: Does not detect current hazardous use as effectively as the AUDIT; once positive, a score will not decrease with sobriety.
- Consequences, Not Quantity: Focuses on consequences rather than drinking frequency or volume.
- Self-Report: Subject to denial or underreporting in evaluative contexts.
References
Selzer, M. L. (1971). The Michigan Alcoholism Screening Test: The derivation and validity of a new diagnostic instrument. American Journal of Psychiatry, 127(12), 1653-1658.
What is the MAST?
The MAST (Michigan Alcohol Screening Test) is a 25-item validated self-report questionnaire developed by Selzer (1971) to identify alcohol use disorder (alcoholism). It is one of the oldest validated alcohol screening tools, with over 50 years of clinical and research use. The MAST uses weighted yes/no questions covering drinking behaviors, consequences, and help-seeking history.
Most MAST items are scored 1 point for "Yes," but five items (items 1, 4, 6, 16, 17) are scored differently, some 1 point for "No," others weighted at 2 or 5 points. Total scores range from 0 to 53. A score of 5 or higher indicates probable alcoholism requiring further evaluation. Scores of 4 are considered suggestive. The weighted scoring makes the MAST more sensitive to severe alcohol dependence indicators compared to simple count-based tools like CAGE.
The SMAST (Short MAST), a validated 13-item short form by Selzer, Vinokur, and van Rooijen (1975), retains good sensitivity and is faster to administer. The MAST and SMAST are in the public domain and widely used in primary care, ED settings, and addiction treatment. They complement the AUDIT (which also detects hazardous use) and CAGE (which is simpler but less sensitive).
Educational reference only. Cannot diagnose or replace clinical evaluation. This tool screens for alcohol use disorder, not drug use (see DAST-10).
Substance Use Screening in HiBoop
MAST alongside AUDIT, CAGE, DAST-10, and CRAFFT, automated scoring and longitudinal substance use outcome tracking across your patient panel.
Frequently Asked Questions
Is the MAST self-report or clinician-administered?
The MAST is a self-report questionnaire, though it can also be administered verbally by a clinician. It consists of 25 yes/no items that the respondent completes based on their own drinking history and related experiences.
What score indicates probable alcohol use disorder on the MAST?
A score of 5 or higher is the conventionally used threshold for probable alcoholism requiring further evaluation, as established by Selzer (1971). A score of 4 is considered suggestive, while scores of 7 or higher are associated with definitive indicators of alcohol dependence. Note that optimal cutpoints vary in the literature; Ross et al. (1990) found 12/13 to be optimal against DSM-III criteria in a treatment-seeking sample.
Can the MAST diagnose alcohol use disorder?
No. The MAST is a screening tool, not a diagnostic instrument. A positive screen indicates that further clinical evaluation is warranted; diagnosis requires a structured clinical interview and full assessment by a qualified clinician.
How does the MAST differ from the AUDIT or CAGE?
The MAST uses a lifetime perspective and weighted scoring across 25 items, making it particularly sensitive to severe and long-standing indicators of alcohol dependence. The AUDIT assesses recent (past year) consumption and is better suited for detecting current hazardous use. The CAGE is a 4-item tool that is simpler to administer but less sensitive than the MAST.
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