Safety and Sobriety Manual
Best Practices in Domestic Violence and Substance Abuse
January 2005
Short Michigan Alcoholism Screening Test
(Note: The form can be found on page 11 of the Appendix Resource (pdf))
Answer YES or NO for each question as it applies.
NAME:
Date of Birth:
Date of Administration:
SMAST
- Do you feel you are a normal drinker? (By normal we mean you drink less than or as much as most other people.)
- Does your partner, a parent, and/or other near relative ever worry or complain about your drinking?
- Do you ever feel guilty about your drinking?
- Do friends or relatives think you are a normal drinker?
- Are you able to stop drinking when you want to?
- Have you ever attended a meeting of Alcoholics Anonymous?
- Has drinking ever created problems between you and your partner, a parent or other near relative?
- Have you ever gotten into trouble at work or school because of drinking?
- Have you ever neglected your obligations, your family, or your work for two or more days in a row because you were drinking?
- 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.)
- 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.).
- Have you ever been arrested for drunken driving, driving while intoxicated, or driving under the influence of alcoholic beverages?
- 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
(Note: The form can be found on page 12 of the Appendix Resource (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 girlfriends/boyfriends 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)
(Note: The chart can be found on pages 13 & 14 of the Appendix Resource(pdf))
The chart provided in the Appendix Section of the Safety & Sobriety Manual is of very low resolution.The following links lead to a web site and a PDF document that seems to be the source of Commonly Abused Drugs: