MAST
Select YES or NO for each item as it applies to you.
Name
First Name
Last Name
1. Do you feel you are a normal drinker? (By normal we mean you drink less than or as much as most other people.)
*
YES
NO
2. Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of the evening?
*
YES
NO
3. Does your wife, husband, a parent , or other near relative ever worry or complain about your drinking?
*
YES
NO
4. Can you stop drinking without a struggle after one or two drinks?
*
YES
NO
5. Do you ever feel guilty about your drinking?
*
YES
NO
6. Do friends or relatives think you are a normal drinker?
*
YES
NO
7. Are you able to stop drinking when you want to?
*
YES
NO
8. Have you ever attended a meeting of Alcoholics Anonymous (AA)?
*
YES
NO
9. Have you gotten into physical fights when drinking?
*
YES
NO
10. Has your drinking ever created problems between you and your wife,husband, a parent, or other relative?
*
YES
NO
11. Has your wife, husband (or other family members) ever gone to anyone for help about your drinking?
*
YES
NO
12. Have you ever lost friends because of drinking?
*
YES
NO
13. Have you ever gotten into trouble at work or school because of drinking?
*
YES
NO
14. Have you ever lost a job because of drinking?
*
YES
NO
15. Have you ever neglected your obligations, your family or your work for two or more days in a row because you were drinking?
*
YES
NO
16. Do you drink before noon fairly often?
*
YES
NO
17. Have you ever been told you have liver trouble? Cirrhosis?
*
YES
NO
18. After heavy drinking have you ever had Delirium Tremens (D.T.s) or severe shaking, or heard voices or seen things that really were not there?
*
YES
NO
19. Have you ever gone to anyone for help about your drinking?
*
YES
NO
20. Have you ever been in a hospital because of drinking?
YES
NO
21. Have you ever been a patient in a psychiatric hospital or on a psychiatricward of a general hospital where drinking was part of the problem thatresulted in hospitalization?
YES
NO
22. Have you ever been seen at a psychiatric or mental health clinic, or goneto any doctor, social worker, or clergyman for help with an emotionalproblem, where drinking was part of the problem?
YES
NO
23. Have you ever been arrested for drunk driving, driving while intoxicated, ordriving under the influence of alcoholic beverages?
YES
NO
If YES, how many times?
24. Have you ever been arrested, or taken into custody even for a few hours,because of other drunk behavior?
YES
NO
If YES, how many times?
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