MAST (Michigan Alcohol Screening Test)

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

1. Lifetime Perspective: Items cover the patient's entire lifetime history, not just recent use.
2. Scoring: Requires applying specific weights to each item. Automated scoring is highly recommended to avoid manual errors.
3. Short Form: The SMAST (13 items) is a validated alternative for settings requiring brevity (positive screen threshold ≥3).
4. 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.

Additional Context

The MAST is a 25-item validated yes/no screening tool for alcohol use disorder, one of the oldest and most widely cited alcohol screens. Score 0–53; ≥5 indicates probable alcoholism. Public domain. Selzer (1971).

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).

MAST Score Interpretation

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.