Michigan Alcohol Screening Test (MAST)

Michigan Alcohol Screening Test (MAST)

PLEASE ANSWER YES OR NO TO EACH QUESTION
Name*

First NameLast Name
Date*

MonthDayYear
Date
0. Do you enjoy drinking now and then?*

YesNo
Points

0
* 1. Do you feel you are a normal drinker? ("normal" - drink as much orless than most other people)*

YesNo
Points

2
2. Have you ever awakened the morning after some drinking thenight before and found that you could not remember a part of theevening?*

YesNo
Points

2
3. Does your wife, husband, a parent, or other near relative ever worry or complain about your drinking?*

YesNo
Points

1
4. Can you stop drinking without a struggle after one or two drinks?*

YesNo
Points

2
5. Do you ever feel guilty about your drinking?*

YesNo
Points

1
* 6. Do friends or relatives think you are a normal drinker?*

YesNo
Points

2
* 7. Are you able to stop drinking when you want to?*

YesNo
Points

2
8. Have you ever attended a meeting of Alcoholics Anonymous(AA)?*

YesNo
Points

5
9. Have you gotten into physical fights when drinking?*

YesNo
Points

1
10. Has you drinking ever created problems between you and your wife, husband, a parent, or other relative?*

YesNo
Points

2
11. Has your wife, husband (or other family members) ever gone to anyone for help about your drinking?*

YesNo
Points

2
12. Have you ever lost friends because of your drinking?*

YesNo
Points

2
13. Have you ever gotten into trouble at work or school because of drinking?*

YesNo
Points

2
14. Have you ever lost a job because of drinking?*

YesNo
Points

2
15. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?*

YesNo
Points

2
16. Do you drink before noon fairly often?*

YesNo
Points

1
17. Have you ever been told you have liver trouble? Cirrhosis?*

YesNo
Points

2
** 18. After heavy drinking have you ever had Delirium Tremens (D.T.s)or severe shaking, or heard voices, or seen things that are reallynot there?*

YesNo
Points

2
19. Have you ever gone to anyone for help about your drinking?*

YesNo
Points

5
20. Have you ever been in a hospital because of drinking?*

YesNo
Points

5
21. Have you ever been a patient in a psychiatric hospital or on a psychiatric ward of a general hospital where drinking was part of the problem that resulted in hospitalization?*

YesNo
Points

2
22. Have you ever been seen at a psychiatric or mental health clinic orgone to any doctor, social worker, or clergyman for help with any emotional problem, where drinking was part of the problem?*

YesNo
Points

2
*** 23. Have you ever been arrested for drunk driving, driving while intoxicated, or driving under the influence of alcoholic beverages? (If YES, How many times?) *
Points

2
*** 24. Have you ever been arrested, or taken into custody even for a few hours, because of other drunk behavior? (If YES, How many times?) *
Points

2
* Alcoholic response is negative
** 5 points for Delirium Tremens
*** 2 points for each arrest
Total Points:*
Should be Empty: