For a paper copy of this document please contact:

Bureau of Domestic and Sexual Violence Prevention
Phone:  217-557-8306
Web Site:  Domestic Violence - Victim Services

Appendix

  1. Short Michigan Alcoholism Screening Test
  2. Michigan Alcoholism Screening Test (MAST)1
  3. Commonly Abused Drugs (Courtesy of NIDA)

Short Michigan Alcoholism Screening Test

(Found on page 11 of the Manual's Appendix (pdf) - Each of the 13 questions are answered with YES or NO)

NAME

Date of Birth

Date of Administration

SMAST

  1. Do you feel you are a normal drinker? (By normal we mean you drink less than or as much as most other people.)
  2. Does your partner, a parent, andlor other near relative ever worry or complain about your drinking?
  3. Do you ever feel guilty about your drinking?
  4. Do friends or relatives think you are a normal drinker?
  5. Are you able to stop drinking when you want to?
  6. Have you ever attended a meeting of Alcoholics Anonymous?
  7. Has drinking ever created problems between you and your partner, a parent or other near relative?
  8. Have you ever gotten into trouble at work or school because of drinking?
  9. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?
  10. Have you ever gone to anyone for help about your drinking? If YES, was this other than Alcoholics Anonymous or a hospital? (If YES, code as YES; if NO, code as NO.)
  11. Have you ever been in a hospital because of drinking? IF YES: Was this for (a) detox; (b) alcoholism treatment; (c) alcohol-related injuries or medical problems, e.g., cirrhosis or physical injury incurred while under the influence of alcohol (car accident, fight, etc.).
  12. Have you ever been arrested for drunken driving, driving while intoxicated, or driving under the influence of alcoholic beverages?
  13. Have you ever been arrested, even for a few hours, because of other drunken behavior?

Note: Husband and wife changed to partner

Michigan Alcoholism Screening Test (MAST)1

(Found on page 12 of the Manual's Appendix (pdf))

Answer Yes or No for each question as it applies to you.

Question YES NO
1. Do you feel you are a normal drinker? 0 2
2. Have you ever awakened the morning after some drinking the night before and found you could not remember a part of the evening before? 2 0
3. Does your partner (or do your parents) ever worry or complain about your drinking? 1 0
4. Can you stop drinking without a struggle after one or two drinks? 0 2
5. Do you ever feel bad about your drinking? 1 0
6. Do friends or relatives think you are a normal drinker? 0 2
7. Do you try to limit your drinking to certain times of the day or to certain places? 0 0
8. Are you always able to stop drinking when you want to? 0 2
9. Have you ever attended a meeting of Alcoholics Anonymous (AA)? 5 0
10. Have you gotten into fights when drinking? 1 0
11. Has drinking ever created problems with you and your partner? 2 0
12. Has your partner (or other family member) ever gone to anyone for help about drinking? 2 0
13. Have you ever lost friends or girlfriendslboyfriends because of drinking? 2 0
14. Have you ever gotten into trouble at work because of drinking? 2 0
15. Have you ever lost a job because of drinking? 2 0
16. Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking? 2 0
17. Do you ever drink before noon? 1 0
18. Have you ever been told you have liver trouble? Cirrhosis? 2 0
19. Have you ever had delirium tremens (DTs), severe shaking, heard voices, or seen things that weren't there after heavy drinking? 5 0
20. Have you ever gone to anyone for help about your drinking? 5 0
21. Have you ever been in a hospital because of drinking? 5 0
22. Have you ever been a patient in 'a psychiatric hospital or on a psychiatric ward of a general hospital where drinking was a part of the problem? 2 0
23. Have you ever been seen at a psychiatric or mental health clinic, or gone to a doctor, a social worker, or clergy for help with an emotional problem in which drinking had played a part? 2 0
24. Have you ever been arrested, even for a few hours, because of drunk behavior? 2 0
25. Have you ever been arrested for drunk driving after drinking? 2 0

1 A score of 4 or more suggests evaluation by an AOD professional

Note: The term wife is replaced by partner.

Commonly Abused Drugs (Courtesy of NIDA)

(Found on page 13 & 14 of the Manual's Appendix (pdf))

The scanned shaded table that is in the appendix of the Safety & Sobriety Manual is very low resolution so instead of possibly mis-reading it when trying to put on the web, the following links lead to a webpage and a pdf that seem to be the source of pages 13 & 14 of the appendix.

Commonly Abused Drugs - Webpage on NIDA's Website

Commonly Abused Drugs Flyer (pdf)