SMAST (13 items)

The Short Michigan Alcohol Screening Test refers to the past 12 months. Answer each question yes or no.

1. Do you feel that you are a normal drinker? (By normal we mean you drink less than or as much as most other people.)

2. Does your wife, husband, a parent, or 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 (AA)?

7. Has your drinking ever created problems between you and your wife, husband, a parent, or other near relative?

8. Have you ever gotten into trouble at work because of your 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?

11. Have you ever been in a hospital because of drinking?

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 behaviors?

Disclaimer: The SMAST is a screening tool only. It does not diagnose alcohol use disorder and is not a substitute for clinical judgment, privacy protections, or local care standards.

SMAST — explained

What the SMAST is

The Short Michigan Alcohol Screening Test (SMAST) is a 13-item yes/no questionnaire derived from the Michigan Alcoholism Screening Test (MAST). Administration materials typically specify a focus on the past 12 months and a low reading burden.

Many programs pair alcohol screens with drug-use screening (e.g. DAST-10) when polysubstance use is possible.

Scoring (1 point per problem-indicating answer)

Total score is the count of items answered in the "problem" direction. Items 1, 4, and 5 are reverse-keyed: a point is awarded for No, not Yes. For items 2–3 and 6–13, a point is awarded for Yes.

Some handouts oversimplify as "each Yes is one point," which would mis-score items 1, 4, and 5; keyed scoring above matches standard clinical use.

Total = number of items answered in the keyed (problem) direction (range 0–13)

Common interpretation bands

Thresholds vary by population and purpose; the bands below reflect widely cited SMAST administration guidance.

0–2

Below usual cut point

Often described as not meeting typical SMAST thresholds for escalating workup on this instrument alone.

3

Borderline

Further inquiry, collateral history, or short-interval follow-up may be appropriate.

4+

Higher concern

Often triggers comprehensive assessment or structured brief intervention pathways per local protocol.

Limitations

Positive and negative screens are not diagnostic; DSM-5 criteria and additional tools (e.g. AUDIT) add specificity.
Denial, stigma, or literacy barriers can skew responses; consider interview and observed consequences.
Substituting "drug use" for drinking is sometimes discussed for the parent MAST family; use validated instruments for other substances unless your protocol specifies otherwise.

Overview

The Short Michigan Alcohol Screening Test (SMAST) is a brief, structured questionnaire used to identify adults who may have problematic alcohol use. It condenses themes from the longer Michigan Alcoholism Screening Test (MAST) into 13 yes/no items, with administration materials typically emphasizing behavior over roughly the prior 12 months. The instrument is oriented toward screening and triage—flagging individuals who warrant a more detailed substance-use history, risk assessment, safety considerations (including withdrawal), and discussion of goals—not toward establishing a formal diagnosis by itself.

In routine care, the SMAST can complement universal screening policies, intake assessments, behavioral health evaluations, hospital transitions, and primary-care prevention workflows. Results should always be integrated with medical history, physical examination, collateral information when appropriate and permitted, laboratory findings where useful, and organization-specific pathways for brief intervention, referral, or specialty evaluation.

Relationship to the full MAST

The original MAST is a broader alcohol-focused inventory with many items spanning social, medical, occupational, and legal consequences of drinking. The SMAST was developed as a shortened derivative intended to reduce respondent burden and administration time while retaining sensitivity to clinically meaningful alcohol-related problems. Because it is shorter, the SMAST is often easier to embed in busy clinical environments; however, like all short screens, it summarizes a limited sample of domains and may miss patterns of risk that are subtle, context-dependent, or denied because of stigma.

Clinicians sometimes encounter multiple published variants in the MAST family; operational details (exact wording, time frame instructions, and scoring keys) should be applied consistently within a program. When comparing results across studies or sites, it is important to confirm that the same item set and scoring rules were used.

Administration and response process

The SMAST is commonly administered as a self-report measure with fixed Yes or No answers. A low reading level and straightforward items support use in diverse settings, though literacy, language, cognitive capacity, and acute intoxication or withdrawal can affect validity. When self-report is not feasible, structured interviewing with neutral wording can approximate the same content if standardized prompts are preserved.

Standard instructions ask respondents to consider the past 12 months, which focuses attention on recent pattern and consequences rather than remote lifetime history alone. This timeframe can improve relevance for current risk while potentially under-weighting long-standing but currently inactive dependence if the individual has recently reduced intake. Clinicians may still explore lifetime course, periods of heaviest use, prior treatment, and relapse triggers when the screen is positive or when clinical suspicion remains high despite a low score.

What the items measure

Although individual calculators may display items in different layouts, the SMAST item content typically clusters into several clinically useful domains:

Self-perception and control: whether the individual considers their drinking “normal” compared with others, whether close contacts view their drinking as normal, and whether they can stop when they intend to—themes that probe insight, perceived comparability, and impaired control.
Interpersonal and social impact: worry or complaint from relatives, conflict attributable to drinking, and consequences that signal strain in important relationships.
Internal distress and help-seeking signals: guilt about drinking, attendance at mutual-help groups such as Alcoholics Anonymous, and prior contact with professionals about drinking—markers that may reflect motivation, shame, prior recognition of problems, or prior attempts to change.
Role functioning: work-related problems and multi-day neglect of obligations tied to drinking, indicating erosion of responsibility and reliability.
Medical and legal severity: hospitalization attributed to alcohol, impaired-driving arrests, and arrests related to intoxicated behavior—high-signal events that often correlate with more severe syndromes, though each item still requires contextual interpretation (for example, legal outcomes vary by jurisdiction and policing practices).

Taken together, the SMAST emphasizes salient consequences and recognized dysfunction. It does not quantify drinks per day directly; therefore, it may be paired with quantity-frequency measures (when appropriate) or tools that estimate risk along consumption gradients, depending on the clinical question.

Scoring: keyed (problem-indicating) responses

The SMAST total score is generally computed as the count of items answered in the direction that indicates alcohol-related problems, yielding a range of 0 to 13. A practical issue is that a subset of items is reverse-keyed relative to plain-language expectations: for some questions, the “problem” answer is No rather than Yes.

Specifically, items that describe self-identification as a “normal drinker,” friends or relatives viewing the person as a “normal drinker,” and being able to stop when one wants to reward a point when answered in the direction suggesting denial of normality, disagreement by important others, or difficulty stopping—operationalized in many keys as No on those items. The remaining items typically award a point for Yes when they affirm consequences, help-seeking, mutual-help attendance, occupational problems, neglected obligations, hospitalization, or arrests.

Some informal handouts incorrectly claim that “every Yes equals one point.” That shortcut mis-scores reverse-keyed items and can distort totals. Clinical and research use should follow the published key for the exact SMAST version in use.

Interpretation bands and clinical meaning

Widely circulated administration materials describe interpretive guidance using broad thresholds rather than a fine-grained continuous scale. A commonly taught framework groups totals as:

0–2: often treated as below typical action cutoffs for the SMAST itself, meaning the screen may not, on its own, compel escalation in settings that use these bands—while still not guaranteeing absence of risk.
3: described as a borderline zone where additional inquiry, collateral clarification, or short-interval follow-up may be reasonable even if immediate specialty referral is not mandatory.
4 or higher: commonly interpreted as indicating a higher likelihood of clinically significant alcohol problems that merit a fuller assessment, structured feedback, safety planning when indicated, and pathway-based referral consistent with local resources.

Thresholds are not universal laws; performance characteristics differ by population base rates, setting, age, comorbid psychiatric illness, and concurrent substance use. Some programs apply different cutoffs for research efficiency or specificity goals. The score should therefore be read as a probabilistic signal that informs next steps rather than a categorical label of disease.

Diagnostic boundaries and complementary tools

A positive SMAST does not equate to alcohol use disorder by default. Formal diagnosis in modern frameworks relies on a pattern of criteria involving impaired control, use despite harm, time spent using, craving (when assessed), tolerance, withdrawal, and role interference—interpreted longitudinally and with clinician judgment. Instruments like the AUDIT or structured interviews may add granularity, especially around consumption levels and spectrum severity.

Because many patients use multiple substances, programs sometimes pair alcohol screens with drug-use screening when history or risk factors suggest polysubstance exposure. Doing so reduces the chance that alcohol-focused results mask stimulant, opioid, benzodiazepine, or cannabis-related risk.

Strengths, biases, and limitations

Strengths include brevity, ease of scoring, and coverage of consequences that patients and clinicians recognize as clinically significant. The yes/no format can speed completion and reduce certain response-scale ambiguities seen in frequency-based questionnaires.

Important limitations include social desirability bias, fear of legal or occupational repercussions, variable insight, and cultural differences in stigma and norms around disclosure. Acute illness, pain, sleep deprivation, or neurocognitive impairment may interfere with comprehension. Individuals with intermittent heavy use may sometimes produce lower scores unless a recent high-risk episode is captured within the timeframe. Conversely, a past arrest or hospitalization can raise totals even when current use is reduced—clinicians should interpret items as indicators to explore trajectory, not as static labels.

Clinical integration and documentation considerations

When a SMAST score crosses program thresholds, useful next steps often include clarifying typical drinking quantity (when assessed), pattern (binge vs daily), withdrawal history, pregnancy status when relevant, medications that interact with alcohol, and co-occurring mental health symptoms. Many systems document screening results to meet quality metrics and to support continuity across visits.

Confidentiality protections and mandated reporting rules vary by region and context; clinicians should follow applicable regulations when discussing legal events and when documenting sensitive material. For individuals with elevated scores, shared decision-making about goals (risk reduction, abstinence, treatment engagement) typically works best when coupled with empathic, nonjudgmental framing and concrete options that match available services.

CalcMD.

Short Michigan Alcoholism Screening Test (SMAST)

Use the 13-item SMAST for past-12-month alcohol screening: keyed yes/no scoring, total 0–13, and common bands (0–2, 3, 4+) for triage and further assessment. Educational tool—not a substitute for clinical evaluation.