Michigan Alcohol Screening Test (MAST): Definition, Description, Scoring, Usage, Advantage and Limitation

Michigan Alcohol Screening Test or MAST is a widely used screening tool designed to assess alcohol-related problems and the likelihood of alcoholism. It consists of 25 questions that inquire about various aspects of alcohol consumption, behaviors, and attitudes. The MAST is used as a screening tool by trained healthcare professionals to assess alcohol-related problems through a standardized questionnaire.

The MAST remains a critical tool in the early detection and management of alcohol-related problems, contributing to improved patient outcomes and more effective treatment strategies.

What is the Michigan Alcohol Screening Test (MAST)?

The Michigan Alcohol Screening Test (MAST) is a screening tool used to assess alcohol consumption and the potential presence of alcohol-related problems in a person. It is a self-report questionnaire that consists of 25 questions designed to identify patterns of alcohol use and the negative consequences associated with excessive drinking. The Michigan Alcoholism Screening Test (MAST), was created by Melvin L Selzer in 1971 and is widely used in both clinical and research settings as a preliminary assessment tool. It helps healthcare professionals and researchers identify individuals who need further evaluation for alcohol-related issues, such as substance abuse or alcohol dependence. 

The MAST asks questions about various aspects of alcohol consumption, such as frequency, quantity, and consequences of drinking. It also includes questions about the individual’s ability to control their alcohol intake and the impact of alcohol on their personal and social life. The test provides a score that helps determine the likelihood of alcohol-related problems.

Selzer, M. L. (1971) in the article titled, The Michigan Alcoholism Screening Test: The quest for a new diagnostic instrument 1653-1658, discusses the development and validation of the Michigan Alcoholism Screening Test (MAST), describing the process of creating the MAST and presents the results of an initial validation study. It explains the structure of the test, which consists of 25 questions, and provides information on scoring and interpretation.

How is the MAST tool Used?

Healthcare professionals administer the test to assess an individual’s alcohol consumption, drinking patterns, and attitudes. Each question is scored, and the total score indicates the likelihood of alcoholism. 

Professionals interpret the results and determine appropriate follow-up actions, such as further assessment, intervention, or referral to specialized treatment services. While the MAST is not a diagnostic instrument, it helps identify individuals who require additional support or treatment. Its efficient and standardized administration aids in the early detection and intervention of alcohol-related issues.

What Questions Does the MAST Tool Contains?

Here are all 25 questions typically included in the Michigan Alcoholism Screening Test (MAST):

1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticizing your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
5. Has a relative, friend, doctor, or other healthcare professional been concerned about your drinking or suggested you cut down?
6. Do you ever take a drink in the morning when you first wake up?
7. Do you drink alone?
8. Do you drink to escape from worries or troubles?
9. Do you drink heavily when you are disappointed, under pressure, or have had a quarrel with someone?
10. Do you feel more at ease and sociable after having a few drinks?
11. Do you find it difficult to stop drinking after you have started?
12. Do you get into financial difficulties as a result of your drinking?
13. Do you give up or reduce important social, occupational, or recreational activities because of drinking?
14. Do you have blackouts, that is, have you ever awakened after a night of drinking not able to remember what happened the night before?
15. Do you have alcoholic tremors (shakes) in the morning?
16. Do you have a feeling of guilt or remorse after drinking?
17. Do you have to drink much more now than you used to in order to get the effect you want?
18. Do you think you are a normal drinker?
19. Have you ever been a patient in a hospital or alcoholic ward because of your drinking?
20. Have you ever been arrested, or taken into custody, even for a few hours, because of drinking?
21. Have you ever been told you have liver trouble, such as cirrhosis?
22. Have you ever had delirium tremens (DTs), severe shaking, visual or auditory (hearing) hallucinations, or seizures (fits) as a result of drinking?
23. Have you ever gone to anyone for help about your drinking?
24. Have you ever had a complete loss of memory (blackout) about your drinking?
25. Have you ever found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating?

These questions cover a range of alcohol-related behaviors, consequences, and symptoms associated with alcoholism. The responses to these questions are used to calculate the total score for the MAST.

How is the MAST Tool Scored and Interpreted?

The scoring and interpretation of the MAST tool follows 4 basic steps, including:

1. Scoring

Each question in the MAST is assigned a specific score. The scores usually range from 0 to 5 or 0 to 1, depending on the version or adaptation of the MAST used. The scoring system varies slightly, but higher scores indicate more severe alcohol-related problems or a higher likelihood of alcoholism.

2. Total Score

The scores from all 25 questions are summed to obtain a total score. The range of total scores varies depending on the scoring system used.

3. Cutoff Scores

Specific cutoff scores are established to classify individuals into different categories or levels of risk. These cutoff scores vary depending on the population being assessed and the purpose of the screening. For example, a lower cutoff score indicates low risk, while a higher cutoff score indicates moderate or high risk for alcoholism.

4. Interpretation

The interpretation of the MAST results involves comparing the individual’s total score to the established cutoff scores. Depending on the score range, the interpretation indicates the presence of alcohol-related problems, the likelihood of alcoholism, or the need for further evaluation.

A positive screening result on the MAST indicates a need for further evaluation and does not provide a definitive diagnosis of alcoholism.

What are the Different Risk Levels Identified by the MAST?

The specific risk levels or categories may vary depending on the scoring system or guidelines used. However, here are risk levels identified by the MAST:

1. Low Risk

People who score below the established cutoff score for low risk are considered to have a lower likelihood of alcohol-related problems or alcoholism. However, it’s important to note that even individuals in the low-risk category still benefit from education about responsible drinking and monitoring their alcohol consumption.

2. Moderate Risk

People who score above the low-risk cutoff score but below a higher cutoff score are classified as moderate risk. This category indicates a higher likelihood of alcohol-related problems or suggests that the individual is at an early stage of alcohol misuse.

3. High Risk

Individuals who score above the moderate-risk cutoff score or reach a designated high-risk cutoff score are considered to be at a higher risk for alcohol-related problems or alcoholism. This category indicates a significant level of alcohol misuse or dependence.

The specific cutoff scores and risk level classification will vary depending on the population being assessed, the purpose of screening, and the guidelines followed by the healthcare professionals administering the MAST.

How Effective is the MAST Tool?

Recent studies have indeed reported varying sensitivity and specificity values for the Michigan Alcoholism Screening Test (MAST), indicating its ability to capture individuals with alcohol-related problems while minimizing false positives.

Sensitivity refers to the test’s ability to correctly identify individuals with alcohol-related problems, while specificity refers to its ability to correctly identify individuals without alcohol-related problems.

A study by Storgaard et al, in the article titled The Validity of the Michigan Alcoholism Screening Test (MAST), reported sensitivity values ranging from around 70% to 95% for the MAST This means that the test can accurately identify a significant proportion of individuals with alcohol-related problems.

The study also reported that specificity values for the MAST range from approximately 50% to 95%, indicating that the test can effectively minimize false positives by correctly identifying individuals without alcohol-related problems.

Another study by Minnich, et al (2018), titled Systematic review of the Michigan Alcoholism Screening Test. Journal of Counseling & Development, 96(3), 335–344, reviewed 103 studies and reported results for reliability, validity, and nonclinical descriptive statistics for the MAST. From the review, the MAST demonstrated high internal consistency across different studies, indicating that it is a reliable tool for screening alcoholism.

What are the Benefits of the MAST Tool?

Here are 6 key benefits of the MAST tool:

1. Early Identification

The MAST helps in the early identification of individuals who are at risk for alcohol-related problems or alcoholism. By screening individuals for alcohol misuse or dependence, the MAST facilitates the early detection of issues before they escalate or cause significant harm.

2. Standardized Assessment

The MAST provides a standardized and structured approach to assessing alcohol consumption and attitudes. It ensures that the same set of questions is asked to each individual, promoting consistency and comparability of results across different screenings and healthcare professionals.

3. Efficient Screening

The MAST is a relatively quick and efficient screening tool. It consists of a set of 25 questions that can be administered relatively rapidly, making it feasible for use in a variety of healthcare settings where time constraints may be a concern.

4. Identification of Treatment Needs

The MAST helps identify individuals who will benefit from additional support, counseling, or treatment for alcohol-related issues. The screening results guide healthcare professionals in determining the appropriate level of intervention or referral to specialized treatment services.

5. Supporting Clinical Decision-Making

The MAST results, in conjunction with clinical judgment, assist healthcare professionals in making informed decisions about further evaluation and treatment. It provides valuable information that help guide the development of personalized treatment plans and interventions for individuals with alcohol-related problems.

6. Patient Engagement

The MAST serves as a tool to initiate conversations about alcohol use and its potential consequences. By engaging individuals in discussions about their drinking habits, the MAST increases awareness and motivate individuals to seek help or make positive changes in their alcohol consumption.

What are the Limitations of The MAST Tool?

Here are 6 key limitations of the MAST to consider:

1. Self-Report Bias

Research by Selzer, M. L. (1967). Michigan Alcoholism Screening Test (MAST) reported that as with any self-report tool, responses can be influenced by the individual’s willingness to report accurately, potentially leading to underreporting or overreporting of alcohol use.

2. Limited Diagnostic Capability

The MAST is a screening tool and not a diagnostic instrument. While it identifies individuals who have a risk of alcohol-related problems, it cannot provide a definitive diagnosis of alcoholism or other alcohol-related disorders. A comprehensive assessment by a healthcare professional is necessary to confirm a diagnosis and determine appropriate interventions.

3. Lack of Contextual Information

The MAST focuses primarily on alcohol consumption and related behaviors. It doesn’t capture important contextual factors that contribute to an individual’s drinking patterns, such as social or cultural influences, co-occurring mental health issues, or underlying stressors.

4. Reliance on Cutoff Scores

The MAST relies on predetermined cutoff scores to determine risk levels. However, the choice of cutoff scores varies across different settings or populations, and there is no universally accepted standard. The selection of cutoff scores requires careful consideration, balancing the trade-off between sensitivity and specificity based on the specific goals of the screening.

5. Lack of Updated Norms

The MAST was developed several decades ago, and the available norms and cutoff scores don’t fully reflect more recent research or changes in alcohol consumption patterns. As a result, the applicability and accuracy of the MAST in contemporary populations or diverse cultural contexts is limited.

How Does the Michigan Alcohol Screening Test (MAST) Help to identify Alcohol Withdrawal Symptoms?

The Michigan Alcohol Screening Test (MAST) is a comprehensive tool used to assess an individual’s alcohol consumption patterns and the negative consequences of excessive drinking. It aids in identifying potential withdrawal symptoms through the following ways:

1. Assessment of Drinking Behaviors: The MAST includes questions that evaluate the frequency and quantity of alcohol consumption. Understanding an individual’s drinking patterns helps determine the risk of alcohol dependence, which is directly linked to withdrawal symptoms.
2. Identification of Physical and Psychological Symptoms: Several questions in the MAST specifically address symptoms that are indicative of alcohol withdrawal. For example:
   • Tremors and Shakes: Questions about experiencing tremors (shakes) in the morning highlight physical dependence, a key factor in withdrawal.
   • Blackouts and Memory Loss: Inquiries about blackouts and loss of memory reflect the neurological impact of excessive drinking and potential withdrawal risks.
   • Delirium Tremens (DTs) and Seizures: Questions regarding experiences of DTs, hallucinations, or seizures indicate severe withdrawal risks.
   • General Withdrawal Symptoms: The MAST asks about symptoms like trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, and sweating, which are common during alcohol withdrawal.
3. Evaluation of Consequences and Control: The MAST assesses the impact of alcohol on an individual’s life, including their ability to control drinking and the social, financial, and occupational consequences of their drinking habits. Difficulty in controlling alcohol intake and significant life disruptions are strong indicators of alcohol dependence, which can lead to severe withdrawal symptoms upon cessation.
4. Scoring and Risk Categorization: The MAST provides a total score based on the individual’s responses, categorizing them into different risk levels:
   • Low Risk: Indicates minimal likelihood of withdrawal symptoms but still necessitates education on responsible drinking.
   • Moderate Risk: Suggests potential early-stage alcohol misuse and mild withdrawal symptoms, requiring brief interventions and monitoring.
   • High Risk: Signifies significant alcohol misuse or dependence, with a high risk of severe withdrawal symptoms such as seizures and delirium tremens, necessitating immediate medical evaluation and intervention.

The MAST helps healthcare professionals identify individuals at risk of experiencing symptoms of alcohol withdrawal. This early identification allows for timely and appropriate interventions, which are crucial in managing and mitigating the potentially severe and life-threatening complications of alcohol withdrawal syndrome.

Is the Michigan alcohol screening test related to the Minnesota model for treatment?

The Michigan Alcohol Screening Test (MAST) and the Minnesota Model for treatment are related in that they both pertain to the identification and treatment of alcohol use disorders, but they serve different purposes and are distinct tools within the broader field of addiction treatment.

The MAST is a screening tool designed to assess the presence and severity of alcohol use disorders. It consists of a series of questions about an individual’s drinking habits and the consequences of alcohol use. The MAST helps identify individuals who may have an alcohol use disorder and who may benefit from further evaluation and potential treatment. It is used primarily in clinical and research settings to quickly gauge the severity of alcohol use issues.

The Minnesota Model, also known as the Hazelden Model, is a comprehensive approach to addiction treatment. It was developed in the 1950s at the Hazelden Foundation in Minnesota. The Minnesota Model is characterized by its holistic approach, integrating medical, psychological, and social aspects of treatment. It typically includes:

• 12-Step Facilitation: Incorporating principles from Alcoholics Anonymous (AA) and other 12-step programs.
• Multidisciplinary Team: Utilization of a team of professionals, including doctors, therapists, and counselors.
• Individualized Treatment Plans: Tailoring treatment to the specific needs of each patient.
• Continuum of Care: Providing a range of services from detoxification to aftercare support.

While the MAST and the Minnesota Model are distinct, they can be related in the following ways:

• Assessment and Diagnosis: The MAST can be used as an initial screening tool within the Minnesota Model to identify individuals who need more comprehensive assessment and treatment.
• Integration: The results of the MAST can inform the individualized treatment plans developed under the Minnesota Model, ensuring that patients receive appropriate levels of care and support.

The MAST is a diagnostic tool used to identify alcohol use disorders, while the Minnesota Model is a holistic treatment approach. Both are important components in the continuum of care for individuals with alcohol use disorders, but they serve different functions within that continuum.

Who can administer the MAST?

The MAST can be administered by trained healthcare professionals, such as doctors, nurses, psychologists, or addiction specialists. These professionals have the knowledge and expertise to interpret the results and provide appropriate guidance based on the screening outcomes.

Is the MAST a diagnostic tool for alcoholism?

No, the MAST is a screening tool and not a diagnostic instrument. It provides an indication of the risk levels for alcohol-related problems but does not provide a definitive diagnosis. A comprehensive assessment by a healthcare professional is necessary for a definitive diagnosis.

Can the MAST be self-administered?

Yes, the MAST can be self-administered by individuals who are capable of understanding and responding to the questionnaire. However, it’s important to note that self-administration may be subject to biases, and it’s generally recommended to have a healthcare professional interpret the results.

What is the difference between the MAST and the CAGE tool?

The Michigan Alcohol Screening Test (MAST) and the CAGE questionnaire are screening tools for alcohol use disorder. The MAST assesses various aspects of alcohol use, while the CAGE focuses on four key indicators of alcohol dependence. MAST has more items (24-25), while CAGE has four questions.

What is the scoring and interpretation of the MAST?

Each item on the MAST is scored based on the severity of the response, with higher scores indicating greater alcohol-related problems or dependence. The total score provides an indication of the individual’s level of alcohol-related risk or impairment.

How is the MAST administered?

The Michigan Alcohol Screening Test (MAST) is typically administered as a self-report questionnaire, where individuals respond to a series of items about their alcohol use and related behaviors. It can be completed in person, online, or through paper forms, depending on the setting and preferences of the administrator.

Is there an advantage of the CAGE test over the MAST test?

Yes, the CAGE test offers advantages over the MAST test due to its simplicity, specificity, ease of use, and extensive research support. With only four questions focused on key indicators of alcohol dependence, it provides a quick and targeted assessment in various healthcare settings.

Can the MAST be used for adolescents or young adults?

While the MAST was originally developed for adults, adaptations and versions of the MAST have been developed for use with adolescents and young adults. These adaptations consider age-appropriate language and relevant factors specific to younger populations.