The MAST (Michigan Alcohol Screening Test): A Clinician Guide

The Michigan Alcohol Screening Test (MAST) is one of the oldest standardized alcohol screening instruments still in clinical use, first published by Selzer in 1971. Its 22 yes/no items cast a wide net across lifetime drinking consequences - social, occupational, medical, and legal - and sum to a score that sorts patients into one of three tiers. This guide covers what the MAST measures, how to score its two reverse-keyed items correctly, its interpretation bands, and where it stands relative to the shorter AUDIT.

What the MAST measures

The MAST screens for lifetime alcohol-related problems and alcohol dependence, rather than focusing narrowly on recent drinking behaviour. Its items ask about self-perception of drinking ("do you feel you are a normal drinker"), family and social consequences, work problems, blackouts, physical health effects, and prior contact with treatment or medical services because of drinking. This breadth is the MAST's defining feature: it captures a lifetime picture of alcohol-related harm rather than a snapshot of the past week or month.

The 22 items and response format

Every item is answered Yes or No, and the instrument is scored across all 22 items - there is no subset of unscored items and no frequency rating. Most items score 1 point for a "Yes" response, reflecting an endorsed problem.

How to score the MAST: two reverse-keyed items

Summing the 22 items gives a total from 0 to 22. Two items - question 1 and question 4 - are reverse-keyed: because they are worded in the protective direction (asking whether the respondent considers their drinking normal, or whether they have ever been able to stop drinking when they wanted to), a "No" answer scores the point on these two items rather than "Yes." Scoring all 22 items in the same direction without accounting for these two reversals is the most common manual scoring error and will understate a patient's true total.

MAST severity bands and cut-off

The 22-point total sorts into three tiers:

• 0-2: No apparent problem
• 3-5: Early or middle problem drinker
• 6-22: Problem drinker

These bands are broad by design - the MAST was built as a case-finding tool, not a fine-grained severity scale, so within the "problem drinker" tier a score of 6 and a score of 20 both fall in the same category despite reflecting very different levels of endorsed harm. As with any screening instrument, the MAST supports rather than replaces a full clinical assessment of alcohol use.

MAST vs AUDIT

Clinicians frequently choose between the MAST and the WHO-developed AUDIT. The MAST's 22 items and lifetime focus make it thorough but longer to administer, and its broad three-tier scoring does not distinguish degrees of risk as finely as more modern instruments. The AUDIT, by contrast, is a 10-item instrument focused on the past year, developed specifically for brief intervention settings and widely used internationally in primary care. Many services have moved toward the AUDIT for routine screening because of its brevity, reserving a lifetime-history instrument like the MAST for cases where a fuller retrospective picture of alcohol-related consequences is clinically useful.

Who administers it, time required, setting

The MAST is a patient self-report measure intended for adults and typically takes about five minutes to complete. Its length relative to newer alcohol screens makes it better suited to intake assessments and specialist addiction settings than to high-volume routine screening, where a briefer instrument is often preferred.

Limitations

Because the MAST asks about lifetime consequences rather than a defined recent time window, it cannot distinguish a patient with a serious drinking problem years in the past who is now stable in recovery from one with an active, current problem - both may score similarly. Its broad three-tier bands also give less granularity than the finer severity scales used by more recent instruments. Like all self-report alcohol screens, results depend on honest disclosure, and a positive screen indicates the likelihood of a problem rather than a diagnosis of alcohol use disorder.

Using the MAST digitally

Digital administration applies the reverse-keyed scoring on questions 1 and 4 automatically, removing the most common source of manual scoring error. The platform calculates the total and tier instantly and produces a clinician-ready report, while repeat administrations - useful for tracking a patient's self-reported alcohol-related consequences over the course of treatment - support measurement-based care without the burden of manual tallying across 22 items. See automated scoring for how this reduces error across a caseload.

Key takeaways

• The MAST is a 22-item yes/no lifetime alcohol screen, scored 0-22.
• Questions 1 and 4 are reverse-keyed - a "No" answer scores the point on these two items.
• Bands: 0-2 no apparent problem, 3-5 early or middle problem drinker, 6-22 problem drinker.
• Its lifetime focus and broad top-tier band make it less granular than a briefer, past-year instrument like the AUDIT.
• Digital scoring automatically applies both reversals, removing the most common manual scoring error.