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CORK Bibliography: MAST (Michigan Alcoholism Screening Test) & Short and Brief Versions

57 citations. 1996 to present

Prepared: June 2008

Beullens J; Aertgeerts B. Screening for alcohol abuse and dependence in older people using DSM criteria: A review. Age and Ageing 8(1): 76-82, 2004. (30 refs.)

Alcohol abuse and dependence in older people are important problems, which frequently remain undetected by health services. Therefore, screening instruments for alcohol abuse and dependence in elderly people would be useful in clinical practice. To assess the quality of screening instruments we performed a literature search in Medline (1966-2002) and PsycINFO (1967-2002). Seven research reports were found. The MAST-G and especially the CAGE appear appropriate. The two questions of Cyr and Wartman, AUDIT and the MAST do not appear appropriate in screening for alcohol abuse and dependence in elderly people in a clinical environment.

Blevins LD; Morton JB; McCabe KA. Using the Michigan Alcoholism Screening Test to identify problem drinkers under federal supervision. Federal Probation 60(2): 38-42, 1996. (17 refs.)

The authors studied the extent of alcohol abuse in a sample of offenders in the federal probation system. The Michigan Alcoholism Screening Test (MAST) was sent to 133 male and female offenders, with 77 usable questionnaires received. Results from the MAST showed a significant number of problem drinkers in this group of federal offenders under supervision in the community; 49% exhibited problem drinking tendencies. Recommendations are made regarding federal probation officer awareness and supervision.

Public Domain

Bombardier CH; Kilmer J; Ehde D. Screening for alcoholism among persons with recent traumatic brain injury. Rehabilitation Psychology 42(4): 259-271, 1997. (29 refs.)

This study examined the clinical utility of various brief screening procedures for identifying persons with a prior history of alcoholism among patients with recent traumatic brain injury (TBI). Participants were 50 patients assessed for various aspects of alcohol use and abuse during their acute rehabilitation hospitalization. Predictive indicators were tested against the Michigan Alcoholism Screening Test (MAST) as the criterion measure. Results indicated the 13-item Short Michigan Alcoholism Screening test is a good proxy for the longer MAST in this population. The two screening questions by Cyr and Wartman (1988) also have some limited utility. Practical implications of the results are discussed with a view toward adopting universal screening for alcoholism among persons with recent TBI.

Bradley KA; Boyd-Wickizer J; Powell SH; Burman ML. Alcohol screening questionnaires in women: A critical review. (review). Journal of the American Medical Association 280(2): 166-171, 1998. (54 refs.)

Objective.-To describe the performance of alcohol screening questionnaires in female patients. Data Sources.-We searched MEDLINE from 1966 to July 1997 for alcoholism or alcohol-drinking and for CAGE, AUDIT, BMAST, TWEAK, T- ACE, MAST, SMAST, or SAAST; Citations Indexes for newer screening questionnaires and those without acronyms; and MEDLINE from 1996 to July 1997 for alcoholism or alcohol-drinking and screening. Study Selection and Data Extraction.-Reviewed studies presented data for women comparing brief alcohol screening questionnaires with valid criterion standards for heavy drinking (greater than or equal to 2 drinks per day) or alcohol abuse or dependence in US general clinical populations. Sensitivities, specificities, and areas under receiver operating characteristic curves (AUROCs) were extracted. Data Synthesis.-Thirteen articles (9 studies) were reviewed. The CAGE questionnaire had AUROCs of 0.84 to 0.92 for alcohol abuse and dependence in predominantly black populations of women, but using the traditional cut point of 2 or more resulted in low sensitivities (38%- 50%) in predominantly white female populations. The TWEAK and Alcohol Use Disorders Identification Test (AUDIT) questionnaires had high AUROCs (0.87-0.93) for past-year alcohol abuse or dependence in black or white women, but had sensitivities less than 80% at traditional cut points. For detecting heavy drinking, the AUDIT questionnaire had AUROCs of at least 0.87 in female primary care patients. The TWEAK and T-ACE questionnaires had higher AUROCs (0.84-0.87) than the CAGE questionnaire (0.76-0.78) for detecting heavy drinking before pregnancy was recognized in black obstetric patients. Conclusions.-The CAGE questionnaire was relatively insensitive in predominantly white female populations. The TWEAK and AUDIT questionnaires have performed adequately in black or white women, using lower cut points than usual.

Breakey WR; Calabrese L; Rosenblatt A; Crum RM. Detecting alcohol use disorders in the severely mentally ill. Community Mental Health Journal 34(2): 165-174, 1998. (25 refs.)

The frequent co-occurrence of alcoholism with serious mental illnesses ("dual diagnosis") necessitates that clinicians are able to recognize its presence in people with disabling mental illnesses. This study demonstrates that professionals often miss the diagnosis, but that their ability to detect alcoholism can be greatly enhanced by the use of a simple screening tool. Members of an urban psychosocial rehabilitation program who received psychiatric treatment in an affiliated outpatient clinic were interviewed after their clinic therapists and rehabilitation counselors had been asked questions pertaining to their general health and substance use, The members were interviewed with two screening tests, the CAGE and the SMAST, and a clinical DSM-III-R diagnosis of alcohol use disorder was established. Both the SMAST and CAGE had good sensitivity and the addition of a screener enhanced the clinicians' ability to detect alcohol use disorders.

Cavaiola AA; Strohmetz DB; Wolf JM; Lavender NJ. Comparison of DWI offenders with non-DWI individuals on the MMPI-2 and the Michigan Alcoholism Screening Test. (rapid communication). Addictive Behaviors 28(5): 971-977, 2003. (21 refs.)

Two groups of driving-while-intoxicated (DWI) offenders with either one DWI offense or with repeat offenses were compared to a group of nonoffenders using the Minnesota Multiphasic Personality Inventory (MMPI-2) and the Michigan Alcoholism Screening Test (MAST). Demographic information was also collected regarding their prior legal history, family history, and blood alcohol level at the time of the DWI arrest. The results indicated both DWI groups had scored significantly higher than the comparison group on the K, Psychopathic Deviate (Pd) Scale, Over-Controlled Hostility (O-H) Scale, and MacAndrews Alcoholism Scale--Revised (MAC-R). The first offenders and multiple offenders did not differ significantly from one another. On the MAST, both DWI offender groups scored significantly higher than the nonoffenders. This time, however, the multiple offenders scored significantly higher than the first-offender group. Unexpectedly, the first offenders and multiple offenders did not differ with regards to blood alcohol level at the time of arrest. There were no significant differences noted with regard to prior legal history or family history of alcoholism for all three groups. These results are discussed with regard to assessment implications.

Chang G; Goetz MA; Wilkins-Haug L; Berman S. Identifying prenatal alcohol use: Screening instruments versus clinical predictors. American Journal on Addictions 8(2): 87-93, 1999. (19 refs.)

The purpose of this study, is to compare the accuracy of screening instruments with clinical predictors in the identification of prenatal alcohol use. 350 women initiating prenatal care at the Brigham and Women 's Hospital (Boston, MA) completed the T-ACE, AUDIT: and SMAST. The predictive accuracy of each was compared using Receiver Operating Characteristic (ROC) curve analysis. The T-ACE, AUDIT, and clinical predictors alone correctly identified 65 to 70% of current drinkers, whereas the SMAST alone performed only slightly better than chance. The predictive ability of the T-ACE was further improved with the addition of clinical predictors.

Cherpitel CJ. Brief screening instruments for alcoholism. Alcohol Health and Research World 21(4): 348-351, 1997. (17 refs.)

This article summarizes brief screening instruments for alcoholism, as well as a set of questions to ascertain quantity and frequency of drinking to ascertain possible harmful use. The tests discussed include the CAGE; the Brief MAST; the Alcohol Use Disorders Identification Test (AUDIT); and the TWEAK. There is also an overview of their use with women and members of minority groups. The group for which these tests are least sensitive is African-American women. The author provides a new test, the Rapid Alcohol Problems Screen (RAPS) drawing upon the most sensitive items from other tests.

Cherpitel CJ. Comparison of screening instruments for alcohol problems between black and white emergency room patients from two regions of the country. Alcoholism: Clinical and Experimental Research 21(8): 1391-1397, 1997. (40 refs.)

A number of brief screening instruments to identify alcohol dependence exist, but the validity of these instruments across ethnic groups or regions of the country is not well established. The sensitivity and specificity of a number of standard screening instruments (CAGE, brief MAST, AUDIT, TWEAK, and RAPS), as well as other measures (History of Trauma Scale, breathalyzer reading, self-reported drinking before the event, and consuming five or more drinks at a sitting at least monthly) are compared against ICD-10 and DSM-IV criteria for alcohol dependence between probability samples of Black and White emergency roam patients in Santa Clara County, CA (n = 716) and in Jackson, MS (n = 1330). Variability in the sensitivity of screening instruments among current drinkers was found to be greater between samples for both Blacks and Whites, than for Blacks compared with Whites within the same sample. The AUDIT, TWEAK, and RAPS seemed to perform well by gender and injury status for both Blacks and Whites in the two samples, and no significant differences were found in the performance of these instruments across sample sites. To evaluate the influence of regional differences in alcohol dependence an differences found in the performance of screening instruments, using logistic regression with the simultaneous entry of demographic variables (age, gender, ethnicity, injury status, and site) and drinking variables (breathalyzer reading, self-reported drinking before the event, and drinking five or more drinks at a sitting at least monthly) to predict alcohol dependence in a merged sample of these patients (Jackson vs. Santa Clara) site was not found to be significant. Data suggest that, whereas region of the country may not be important in predicting alcohol dependence in emergency room populations, regional differences in the performance of screening instruments for alcohol dependence may exist, even when ethnicity is taken into account. Given distinct regional differences in drinking patterns and problems in the U.S., further research on commonly used screening instruments is needed to determine those screeners most efficient for identifying problem drinking.

Cherpitel CJ. Differences in performance of screening instruments for problem drinking among blacks, whites and hispanics in an emergency room population. Journal of Studies on Alcohol 59(4): 420-426, 1998. (38 refs.)

Objective: The purpose of this study was to compare the performance of a number of standard screening instruments for alcohol dependence and harmful drinking/abuse by ethnicity (black, Hispanic and white) and by ethnicity and gender in an emergency room setting. Method: A probability sample of patients (N = 1,429) was breath analyzed and interviewed at the Santa Clara Valley Medical Center in San Jose, California. Sensitivity and specificity were analyzed among current drinkers (n = 857) for the CAGE, Brief MAST, AUDIT, TWEAK, RAPS and other items against combined ICD-10 or DSM-IV criteria for alcohol dependence and separately for alcohol dependence or harmful drinking or abuse. Results: Screening measures were not found to perform equally well by ethnicity or gender, with lower sensitivity found for women compared to men. Consistency in sensitivity of measures was found to vary considerably across ethnic and gender groups, with some measures (most notably the RAPS and the AUDIT) showing consistently high sensitivity across subgroups. None of the instruments performed nearly as well for identifying alcohol dependence or harmful drinking or abuse combined as for alcohol dependence alone. Conclusions: Analyses suggest that, while the RAPS may hold promise for identifying problem drinkers across ethnic and gender subgroups, it and other screening instruments currently in use require additional evaluation in a variety of settings to determine their usefulness for identifying those who could benefit from a brief intervention or referral for problem drinking.

Cherpitel CJ. Gender, injury status and acculturation differences in performance of screening instruments for alcohol problems among US Hispanic emergency department patients. Drug and Alcohol Dependence 53(2): 147-157, 1999. (44 refs.)

The sensitivity and specificity of several screening instruments including the CAGE, brief MAST, AUDIT, TWEAK, RAPS, and Trauma Scale, were evaluated against both ICD-IO and DSM-IV criteria for alcohol dependence and for harmful drinking and abuse in a probability sample of 586 Hispanic emergency department patients. Screening instruments were not as sensitive for females as for males, for those in the low acculturation group, or for non-dependent drinkers. Acculturation was positively associated with the likelihood of being a current drinker, and among current drinkers, was positively associated with alcohol dependence and with harmful drinking or alcohol abuse.

Clements R. A critical evaluation of several alcohol screening instruments using the CIDI-SAM as a criterion measure. Alcoholism: Clinical and Experimental Research 22(5): 985-993, 1998. (54 refs.)

Four alcohol screening instruments (the AUDIT, CAGE, MAST, and Svanum's scale) were administered to a sample of 306 undergraduate students at a Midwestern university and were compared with regard to several test characteristics, using the alcohol section of the CIDI- SAM (DSM-IV version) as the criterion measure. The performance of these instruments was evaluated using two subsets of subjects: (1) students who currently met diagnostic criteria for alcohol dependence (n = 35); and (2) students who met diagnostic criteria for alcohol dependence in the past and/or at present (i.e., lifetime diagnosis; n = 50). The AUDIT performed significantly better than the other three instruments in identifying students who were currently alcohol dependent, providing a moderate degree of clinical utility with this group. The four instruments did not differ significantly in their ability to identify students with a lifetime diagnosis; each measure provided only a modest degree of clinical utility with this group.

Conley TB. Construct validity of the MAST and AUDIT with multiple offender drunk drivers. Journal of Substance Abuse Treatment 20(4): 287-295, 2001. (29 refs.)

The construct validity of the Michigan Alcoholism Screening Test (MAST) and the Alcohol Use Disorders Identification Test (AUDIT) in screening for current DSM-IV alcohol dependence disorders with persons convicted of multiple offenses of Driving Under the Influence (DUI) is evaluated. These tests were administered to 126 DUI offenders presenting for court-ordered inpatient treatment at an agency. DSM-IV alcohol disorders are evaluated for a representative subset of clients in this program using National Longitudinal Alcohol Epidemiologic Surveys' DSM-IV Alcohol Dependence Diagnostic Criteria and Associated Questionnaire Items. Both instruments exhibit acceptable internal consistency. The MAST and The AUDIT correlate moderately well with each other (r = 0.617). The MAST correlates more highly (r = 0.602) than the AUDIT (r = 0.432) with DSM-IV. Future research should examine if the results reported here apply to other multiple offender DUI programs. It is recommended that such programs employing test instruments evaluate their construct validity in a similar method.

Cremonte M; Cherpitel CJ. Performance of screening instruments for alcohol use disorders in emergency department patients in Argentina. Substance Use & Misuse 43(1): 125-138, 2008. (32 refs.)

The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen ( RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.

Crowe RR; Kramer JR; Hesselbrock V; Manos G; Bucholz KK. The utility of the 'Brief MAST' and the 'CAGE' in identifying alcohol problems: Results from national high-risk and community samples. Archives of Family Medicine 6(5): 477-483, 1997. (30 refs.)

Background: The CAGE and the Brief MAST questionnaires are widely used to screen for alcohol problems. We tested the performance of these instruments in 2 population-based groups: a high-risk sample composed of relatives of alcoholic subjects and a community sample consisting of families not selected for alcoholism; i.e, alcohol dependence disorder). Methods: A total of 3435 relatives of alcoholics and 795 control subjects were interviewed with the Semi-Structured Assessment for the Generics of Alcoholism (SSAGA) semistructured interview in a multicenter collaborative study on the genetics of alcoholism. The performance of "CAGE" and "Brief MAST" equivalent items in the SSAGA was characterized by their positive predictive value, sensitivity, specificity, and percentage of the sample who screened positive. Results: Both questionnaires performed well in the highrisk sample, where the base rate of alcoholism was 35%. However, in the community sample, where the 16% rate of alcoholism was comparable to that of the US population (14%),an acceptable positive predictive value could be achieved only through a substantial reduction in sensitivity. Results were similar when men were compared with women and when lifetime alcoholics were compared with current alcoholics. Conclusion: The "Brief MAST" and "CAGE" can be effective instruments to screen for significant alcohol problems in both community and high-risk patients; as expected, their positive predictive value increases with the base rate of alcoholism in the population being screened.

Crowe RR; Kramer JR; Hesselbrock V; Manos G; Bucholz KK. The utility of the 'Brief MAST' and the 'CAGE' in identifying alcohol problems: Results from national high-risk and community samples. Archives of Family Medicine 6(5): 477-483, 1997. (30 refs.)

Dyson V; Appleby L; Altman E; Luchins DJ; Delehant M. Efficiency and validity of commonly used substance abuse screening instruments in public psychiatric patients. Journal of Addictive Diseases 17(2): 57-76, 1998. (51 refs.)

Background: The more commonly used screening instruments for substance abuse were largely developed for addictive populations. We compared several alcohol and drug abuse scales to determine their efficiency and validity for psychiatric patients. Method: The subjects were 100 consecutively admitted patients to a public psychiatric facility. DSM-III-R diagnoses obtained from the alcohol and drug scales of the SCID-P were the criterion measure. Methods of reliability included inter-rater agreement, estimates of internal consistency, and repeat test administration. Sensitivity, specificity and more infrequently used accuracy indices, such as likelihood ratios and Receiver Operating Characteristic (ROC) analysis, were utilized to assess scale validity. Results: First, the reliability of all scales was high. Second, the instruments generally demonstrated highly acceptable levels of screening accuracy. Third, the intake evaluation was as reliable and valid as screening after admission on the unit. Finally, instruments were least discriminating for current problems (past 30 days). Conclusions: Lifetime measures were found to be reliable and valid for public psychiatric patients but further research is needed on increasing the accuracy of screening for current substance abuse problems and the effectiveness of multiple screening approaches.

Fink A; Tsai MC; Hays RD; Moore AA; Morton SC; Spritzer K; Beck JC. Comparing the alcohol-related problems survey (ARPS) to traditional alcohol screening measures in elderly outpatients. Archives of Gerontology and Geriatrics 34(1): 55-78, 2002. (48 refs.)

Older drinkers may incur alcohol-related risks at low consumption levels, but commonly used screening measures do not address alcohol's effects among persons with declining health and increased medication use. We compared the newly developed Alcohol-Related Problems Survey (ARPS) to three validated alcohol screens: the Cut down, Annoyed, Guilty, Eye-opener (CAGE), Short-Michigan Alcohol Screening Test (SMAST), and Alcohol-Use Identification Test (AUDIT). The ARPS classifies drinking as non-hazardous, hazardous or harmful. Non- hazardous drinking is defined as consumption with no known risks for adverse physical or psychological health events. Hazardous drinking is consumption with such risks. Harmful drinking results in adverse events. The AUDIT screens for hazardous and harmful drinking; the CAGE and SMAST identify abusive (e.g. failure to fulfill social obligations) and dependent (e.g. having withdrawal symptoms) drinkers. In this study of 574 current drinkers 65 years and older who completed the ARPS and AUDIT in primary care clinics, half were randomly assigned to complete the CAGE and half, the SMAST. Drinkers who screened positive on the CAGE, SMAST or AUDIT were correctly classified by the ARPS as hazardous or harmful drinkers 91, 75, and 100% of the time, respectively. The majority of ARPS-identified hazardous or harmful drinkers did not screen positive on the CAGE, SMAST or AUDIT. These drinkers had medical conditions or used medications that placed them at risk for adverse health events, none of which was addressed in these three screens. In this study, the ARPS identified nearly all drinkers detected by the CAGE, SMAST, and AUDIT and detected hazardous and harmful drinkers not identified by these measures.

Gache P; Michaud P; Landry U; Accietto C; Arfaoui S; Wenger O et al. The Alcohol Use Disorders Identification Test (AUDIT) as a screening tool for excessive drinking in primary care: Reliability and validity of a French version. Alcoholism: Clinical and Experimental Research 29(11): 2001-2007, 2005. (43 refs.)

Background: Excessive drinking is a major problem in Western countries. AUDIT (Alcohol Use Disorders Identification Test) is a 10-item questionnaire developed as a transcultural screening tool to detect excessive alcohol consumption and dependence in primary health care settings Objectives: The aim of the study is to validate a French version of the Alcohol Use Disorders Identification Test (AUDIT) Methods: We conducted a validation cross-sectional study in three French-speaking areas (Paris, Geneva and Lausanne). We examined psychometric properties of AUDIT as its internal consistency, and its capacity to correctly diagnose alcohol abuse or dependence as defined by DSM-IV and to detect hazardous drinking (defined as alcohol intake > 30 g pure ethanol per day for men and > 20 g of pure ethanol per day for women). We calculated sensitivity, specificity, positive and negative predictive values and Receiver Operator Characteristic curves. Finally, we compared the ability of AUDIT to accurately detect "alcohol abuse/dependence" with that of CAGE and MAST Results: 1207 patients presenting to outpatient clinics (Switzerland, n = 580) or general practitioners' (France, n = 627) successively completed CAGE, MAST and AUDIT self-administered questionnaires, and were independently interviewed by a trained addiction specialist. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT 13 for males, sensitivity 70.1%, specificity 95.2%, PPV 85.7%, NPV 94.7% and for females sensitivity 94.7%, specificity 98.2%, PPV 100%, NPV 99.8%); and hazardous drinkers (with AUDIT 7, for males sensitivity 83.5%, specificity 79.9%, PPV 55.0%, NPV 82.7% and with AUDIT >= 6 for females, sensitivity 81.2%, specificity 93.7%, PPV 64.0%, NPV 72.0%). AUDIT gives better results than MAST and CAGE for detecting "Alcohol abuse/dependence" as showed on the comparative ROC curves. Conclusions: The AUDIT questionnaire remains a good screening instrument for French-speaking primary care.

Gache P; Michaud P; Landry U; Accietto C; Arfaoui S; Wenger O et al. The Alcohol Use Disorders Identification Test (AUDIT) as a screening tool for excessive drinking in primary care: Reliability and validity of a French version. Alcoholism: Clinical and Experimental Research 29(11): 2001-2007, 2005. (43 refs.)

Gentilello LM; Villaveces A; Ries RR; Nason KS; Daranciang E; Donovan DM et al. Detection of acute alcohol intoxication and chronic alcohol dependence by trauma center staff. Journal of Trauma 47(6): 1131-1135, 1999. (35 refs.)

Background: Trauma patients with acute alcohol intoxication or chronic alcohol dependence are at greater risk for morbidity and mortality. We hypothesized that relying on clinical suspicion to detect acute alcohol intoxication and chronic alcohol dependence in trauma patients is inaccurate, influenced by injury factors, and biased by race, gender, age, and socioeconomic status. Methods: Trauma patients were screened with a blood alcohol concentration and with the Short Michigan Alcohol Screening Test and CAGE questionnaire. Before screening, physicians and emergency department nurses were asked whether the patient was acutely intoxicated (blood alcohol concentration > 100 mg/dL) or had a chronic alcohol problem. Sensitivity, specificity, positive, and negative predictive values were determined by comparing responses with blood alcohol concentration, Short Michigan Alcohol Screening Test, and CAGE questionnaire results, stratified by injury and demographic factors. Results: Clinical evaluations were obtained on 462 patients. Overall, 23% of acutely intoxicated patients were not identified by physicians. The miss rate increased to one third in severely injured, chemically paralyzed, or intubated patients. Specificity was also poor. Patients with a negative blood alcohol concentration were more likely to be falsely suspected of intoxication if they were either young, male, perceived as disheveled, uninsured, or having a low income (p < 0.05). Staff identified < 50% of patients with a positive Short Michigan Alcohol Screening Test or CAGE, and falsely identified 26% of patients as alcoholic. Conclusions: Formal alcohol screening should be routine because clinical detection of acute alcohol intoxication and dependence is inaccurate. Screening should also be routine to avoid discriminatory bias attributable to patient characteristics.

Gupman AE; Svikis D; McCaul ME; Anderson J; Santora PB. Detection of alcohol and drug problems in an urban gynecology clinic. Journal of Reproductive Medicine 47(5): 404-410, 2002. (19 refs.)

OBJECTIVE: To compare screening instruments for their utility to detect substance use problems in women seeking gynecologic care, to assess the likelihood that alcohol/drug problems mill be detected by physicians during a routine office visit and to examine the relationship between regular alcohol and/or drug use and the patient's presenting gynecologic complaints. STUDY DESIGN: Women (N = 360) attending a hospital-based gynecology clinic were screened prior to physician visit using the Michigan Alcoholism Screening Test, CAGE and T-ACE. After the visit, information on presenting complaint and physician's documentation of the patient's tobacco, alcohol and other drug use was abstracted from the medical record. RESULTS: The rates of alcohol and illicit drug use varied across assessment instruments; physician documentation, however, yielded the lowest prevalence estimates. Regular alcohol and drug users were more likely to present with chronic and acute medical problems than patients who were not regular users of these substances. CONCLUSION: The gynecology clinic offers an opportunity for early identification of women with substance problems, and alternative strategies are needed to encourage gynecologists to routinely screen for such problems at each medical visit.

Gutgesell ME; Schorling JB; Gressard CF. Runners' alcohol use and responses to the Brief MAST. Substance Abuse 17(2): 77-85, 1996. (29 refs.)

The authors assessed drinking habits and responses to the Brief Michigan Alcoholism Screening Test (BMAST) in runners (students and nonstudent) participating in a 10-mi race. Questionnaires were sent to 1445 race registrants: 483 nonstudent men, 153 student men, 154 nonstudent women, and 105 student women responded (62% total response rate). The authors compared the student runners' responses to BMAST questions, as well as binge rates and family history of problem drinking, to those of a reference college-student (slightly younger) population from the same state (n= 3726). The male student-runner binge drinking rate was 50% and the women student-runner rate was 47.6%, similar to those of the comparison group. There was no difference in rates of an "alcoholic score" on the BMAST among student runners (10.4% men, 5.1% women) compared to other runners. Student runners were more likely to have sought help for their drinking compared to nonrunner students. Nearly 20% of subjects in the student groups (runners and nonrunners) reported at least one parent with problem drinking, significantly lower than the 28% reported by nonstudent runners. These data suggest that running may be a healthy substitute for drinking and warrant further investigation.

Henderson-Martin B. No more surprises: Screening patients for alcohol abuse. American Journal of Nursing 100(9): 26-32, 2000. (24 refs.)

This continuing education column deals with screening for alcohol-related problems. The common screening instruments are included as well as nursing assessment tools.

Hirata ES; Almeida OP; Funari RR; Klein EL. Validity of the Michigan Alcoholism Screening Test (MAST) for the detection of alcohol-related problems among male geriatric outpatients. American Journal of Geriatric Psychiatry 9(1): 30-34, 2001. (36 refs.)

Alcoholism is a frequent and underdiagnosed mental health problem of later life. Its detection often relies on the use of screening instruments such as the Michigan Alcoholism Screening Test (MAST). The authors investigated the properties of the scale in a sample of 122 older adults recruited from a geriatric outpatient service in Sao Paulo, Brazil. Thirty-five subjects met criteria for the diagnosis of alcohol abuse or dependence according to DSM-III-R. The cutoff point 4/5 was associated with a sensitivity of 91.4% specificity, of 83.9%, and positive and negative predictive values of 69.6% and 96.0%, respectively. These results indicate that the MAST is a good screening test for the detection of alcohol abuse and dependence in an elderly male population and that the MAST should be used in combination with a questionnaire assessing the frequency-quantity of alcohol consumption to optimize the detection of cases and characterize their current drinking patterns.

Hwu HG; Gorenc KD; Peredo S; Hwang TJ; Abreu LF; Chen CC. Brief alcoholism screening questionnaire: Establishment and validity in Taiwanese. Journal of the Formosan Medical Association 102(4): 250-256, 2003. (28 refs.)

Background and Purpose: There has been a marked increase in the prevalence of alcoholism in the Taiwanese population over the past 6 decades. This study was designed to establish a Taiwanese Brief Alcoholism Screening Questionnaire (BASQ) for use in early detection in medical and public health settings. Methods: Interview data were collected from the database of the Taiwan Psychiatric Epidemiological Project (TPEP). The TPEP interviews had been conducted using the Chinese-modified version of the Diagnostic Interview Schedule (DIS-CM) that included a section on alcoholism diagnosis. Data collected from a community sample of 13,373 subjects was used in this study. Twenty nine DIS-CM items for alcoholism diagnosis were entered into an analytic model with 7 statistical filters to identify cross-cultural items. A brief alcoholism screening questionnaire was constructed using these selected items. The validity of the questionnaire was tested in subjects (n = 457) recruited from a local medical center, a hospital clinic, and an alcoholism clinic of a psychiatric center. Results: Four cross-cultural items were identified and the BASQ was constructed. This BASQ had a best cut-off point of 3 with adequate sensitivity (0.86 to 0.88), specificity (0.88 to 0.89), and positive prediction rate (0.90 to 0.91). It detected a varying prevalence of alcoholism (10.1 to 90.3 %) in diverse clinical settings. Conclusions: A 4-item BASQ was established with adequate validity for clinical and public health application in the early detection of alcoholism in Taiwanese subjects.

Knight JR; Palacios J; Shannon M. Unanticipated reactions to a recent report on alcohol problems among pediatric residents. (letter). Archives of Pediatrics & Adolescent Medicine 154(6): 635-635, 2000. (6 refs.)

This is note is in response to criticisms that arouse following the publication of an earlier report "Prevalence of alcohol problems among pediatric residents" (153:1181-1183, 1999.) The data on pediatric resident MAST scores had been secured as part of an educational exercise, had not involved informed consent, and aroused concerns and raised criticisms by the trainees. The response to the publication, the ethical issues raised are described.

Lapham SC; Skipper BJ; Simpson GL. A prospective study of the utility of standardized instruments in predicting recidivism among first DWI offenders. Journal of Studies on Alcohol 58(5): 524-530, 1997. (32 refs.)

Objective: The present study investigated the utility of four instruments -- the MacAndrews scale of the MMPI-2 (MAC), four scales of the Alcohol Use Inventory (AUI), the Michigan Alcoholism Screening Test (MAST) and the Skinner's Trauma Scale (STS) -- in assessing risk for re-arrest among first driving while impaired (DWI) offenders. Method: Subjects were clients (N = 1,384, 80% male) convicted of a DWI offense who were referred to the Lovelace Comprehensive Screening Program for evaluation and who completed a court-mandated screening program. Stratified life table analysis was used to determine re-arrest rates in the period following the screening referral. Results: After 4 years of follow-up the overall rearrest rate was 21.0%. The best predictors of recidivism were a MAC score of 23 or above, elevated scores on AUI scales, young male status (age 30 or under) and arrest blood alcohol concentration (BAC) of .200% or above. The best schematic for classifying first offenders into risk groups was determined using the risk factors above and defined groups with recidivism rates ranging from 13.0% to 38.8%. Conclusions: We were able to identify cohorts of first offenders at relatively low and high risk for recidivism using a stratified analysis with six strata defined from four variables. The MAC was the best, single variable for classifying offenders' future recidivism risk, indicating that, in addition to evaluating for the presence and severity of alcohol and drug use, screening programs for DWI offenders should carefully evaluate personality factors in making referral and sentencing recommendations.

Laugharne RA; Daniels OJ; Lutchman R. The prevalence of alcohol problems amongst in-patients referred to the liaison psychiatrist. Addiction Research 5(5): 379-382, 1997. (16 refs.)

Alcohol related problems amongst patients referred to a liaison psychiatric service have been examined in terms of primary diagnosis but the prevalence has not been estimated using screening instruments. The aim of this study was to establish the prevalence of alcohol related problems using the CAGE and brief MAST screening questionnaires together with data on self reported weekly alcohol consumption and ICD-10 diagnosis. On a sample of 100 consecutively referred patients with a response rate of over ninety percent we found 34.0% to be positive for "alcoholism" on the CAGE, 25.5% on the MAST and 13.8% to have a diagnosis of alcohol dependence syndrome. The mean self reported weekly alcohol consumption was 28.4 units per week. Excessive alcohol consumption and misuse were much more prevalent in male referrals. We conclude that it would be advantageous for liaison services to work closely with alcohol services.

Lennings CJ. The Brisbane North Alcohol and Drug Service Comorbidity Symposium. Part 2. The development of a methodology: Drug use and emotional state in university students. IN: Alcohol and Drug Foundation. Drugs: Policies, Programs and People. 1996 Conference Papers. Spring Hill, Queensland Australia: Alcohol and Drug Foundation, 1996. pp. 142-149. (9 refs.)

This paper reports efforts to investigate the psychometric properties of some screening tests used in a study of the association between emotional disturbance and problematic alcohol use. Previous study suggested that ther is an interaction of mental health factors and alcohol use among college students, (Carnatta and Nogoshi), but whether the relationship was causal could not be ascertained. The measures examined here included the AUDIT, Leeds Dependency Scale, the Faagestrom Index, the Brief MAST, the CAGE, and a 10 item comorbidity scale developed for this research.

Luczak SE. Construct of alcohol problems: Invariance across religions. Dissertation Abstracts International 63(9): 4377B, 2003

This study examined whether measures used to assess alcohol problems among individuals from religions with different alcohol norms capture different concepts of alcohol problems. Tests were conducted of measurement invariance (the same construct being measured across groups) with drinkers from three Mauritian religious groups with different alcohol use norms: (1) Hindus (n = 465), whose religion has only vague warnings regarding alcohol use; (2) Catholics (n = 223), whose religion condones alcohol use; and (3) Muslims (n = 59), whose religion strictly forbids alcohol use. Subjects were administered the Michigan Alcoholism Screening Test (MAST) and factor invariance was compared among the three groups. Factor invariance was obtained for the Hindu and Catholic groups, but not for the Muslim sample. A modified model was designed to fit the Muslim data alone. Additional modeling determined that the difference in the factor structure for Muslims was not due to the predominance of males in the sample, but may have been due to the small sample size. Catholic and Hindu MAST scores could be directly and meaningfully compared, but direct comparisons to the Muslim MAST scores could not be interpreted. The establishment of measurement invariance is necessary in order to accurately assess group differences.

Luczak SE; Raine A; Venables PH. Invariance of the MAST across religious groups. Journal of Studies on Alcohol 62(6): 834-837, 2001. (26 refs.)

Objective: The Michigan Alcoholism Screening Test (MAST), a commonly used instrument of alcohol-related problems, was examined to determine whether it assessed the same constructs in individuals from religions with different proscriptions regarding the use of alcohol. Method: The MAST was completed by participants in the longitudinal Joint Child Health Project when they were approximately 23 years old. Subjects of this study (N = 747; 505 men) were 465 Hindus, 223 Catholics and 59 Muslims who reported drinking alcohol. Measurement invariance, the determination that the same constructs are being measured across groups, was tested by comparing factor invariance using multigroup structural equation modeling. Results: The Hindu and Catholic groups had similar factor structures to those found in previous Australian, Canadian and U.S. samples, Metric invariance was obtained for the Hindu and Catholic groups, but not for the Muslim group. Conclusions: These findings suggest the measurement of MAST factors is invariant across a fairly broad segment of the population in which the MAST might be used. However, the lack of invariance in this sample of Muslims suggests that the MAST is not an appropriate instrument to use among all groups of drinkers. These findings highlight the importance of testing for invariance when using psychological measures to compare heterogeneous samples.

MacKenzie DM; Langa A; Brown TM. Identifying hazardous or harmful alcohol use in medical admissions: A comparison of AUDIT, CAGE and Brief MAST. Alcohol and Alcoholism 31(6): 591-599, 1996. (40 refs.)

Two hundred and forty new medical inpatients received the Alcohol Use Disorders Identification Test (AUDIT), CAGE and brief Michigan Alcoholism Screening Test (brief MAST) questionnaires. Sensitivities when identifying weekly drinkers of gt 14 units (women) or gt 21 units (men) were 93, and 35%, respectively (P lt 0.001). Sensitivities to gt 21 units (women) or gt 28 units (men) were 100%, 94% and 47%. Routine screening of medical admissions with the AUDIT (cut-off score 8) is recommended

Markianos M; Lykouras L; Moussas G; Hatzimanolis J. Changes in dopamine receptor responsivity during alcohol detoxification may predict relapse. Drug and Alcohol Dependence 64(3): 363-365, 2001. (29 refs.)

In the search for clinical and biological variables that may predict relapse of alcohol dependent patients after detoxification, we followed up for 1 year male patients that had undergone successful detoxification. The patients had been tested earlier during their usual alcohol consumption and immediately after detoxification for the responsivity of D2 dopamine receptors (as measured by the increases in prolactin plasma levels caused by intramuscular administration of 5 mg of the dopamine receptor blocker haloperidol). Of the 18 patients, eight had not consumed alcohol for more than 6 months, and ten had relapsed within 6 months. Comparison of the clinical and neuroendocrine data for the two subgroups revealed no significant differences in age, amount of alcohol consumed during alcohol abuse, score in the Beck Depression Inventory, score in the Brief Michigan Alcoholism Screening Test, or prolactin responses to haloperidol before detoxification. in patients who relapsed, the duration of alcoholism was marginally shorter (P = 0.055). Patients who did not relapse had significantly higher (P = 0.003) prolactin responses to haloperidol in the test performed after detoxification as compared with patients who did relapse, and their responses were similar to those of a group of healthy male subjects. The results show that the increase in dopamine receptor responsivity that occurs after detoxification is a favourable factor for non-relapse; it may reflect recovery from down-regulation of the dopaminergic reward system caused by alcohol consumption.

Markianos M; Moussas G; Lykouras L; Hatzimanolis J. Dopamine receptor responsivity in alcoholic patients before and after detoxification. Drug and Alcohol Dependence 57(3): 261-265, 2000. (24 refs.)

Objective: To assess central dopamine receptor responsivity in alcoholic patients during their usual alcohol consumption and after detoxification. Method: plasma prolactin levels were measured at 0, 30, 60, and 90 min after administration of 5 mg haloperidol i.m. in 21 hospitalized male alcoholic patients during usual alcohol consumption, and 13 days later (mean, range 7-17 days), after detoxification. The test was also performed in seven healthy male volunteers. The patterns of prolactin responses were compared using repeated measures analysis of variance. Results: The prolactin responses to haloperidol increased significantly after detoxification compared to those during usual alcohol consumption (state x time interaction P < 0.01; planned comparisons for times 0 and 90 min between states P = 0.03). Compared to controls, the responses of the patients before detoxification were lower (group-time interaction P = 0.001), and the difference was not significant after detoxification (P = 0.19). The magnitude of plasma prolactin (PRL) responses were not related to duration of alcohol abuse, score in the Brief Michigan Alcoholism Screening Test (BMAST) scale, or family history of alcoholism. Conclusions: Alcohol detoxification is accompanied by a normalization of the low responsivity of central dopaminergic receptors during alcohol abuse. The data support the hypothesis of a participation of the central dopaminergic system in alcohol dependence.

Mengel MB; Searight HR; Cook K. Preventing alcohol-exposed pregnancies. (review). Journal of the American Board of Family Medicine 19(5): 494-505, 2006. (103 refs.)

Fetal alcohol exposure affects approximately 1% to 3% of live births in the United States. Family physicians are in a unique position to reduce the incidence of alcohol-exposed pregnancy. Fetal alcohol exposure can be minimized through 2 general approaches: reducing alcohol consumption or increasing effective contraception among childbearing-aged women who engage in "at-risk" drinking and encouraging pregnant women to abstain from alcohol. Although no safe level of alcohol consumption during pregnancy is established, women who binge drink are more likely to deliver infants with physical and cognitive-developmental anomalies. Screening tools, such as quantity/frequency questions, the TWEAK and the T-ACE, developed specifically for prenatal care, are more useful with women than the CAGE and Michigan Alcohol Screening Test (MAST). Screening alone seems to reduce alcohol use among pregnant women. Brief interventions, including education about alcohol's effects on the developing fetus, are effective among women not responding to screening. Unfortunately, many barriers exist to effective implementation of alcohol-exposed pregnancy (AEP) prevention in the clinical setting. Designing effective office base systems so the entire burden of implementing AEP prevention activities doesn't fall solely on the family physician is critical.

Moore AA; Beck JC; Babor TF; Hays RD; Reuben DB. Beyond alcoholism: Identifying older, at-risk drinkers in primary care. Journal of Studies on Alcohol 63(3): 316-324, 2002. (36 refs.)

Objective: To evaluate the validity and reliability of two self- report instruments: the Alcohol-Related Problems Survey (ARPS) and its shorter version the Short ARPS (shARPS) that identify older persons whose use of alcohol alone or with their comorbidities may be placing them at risk for or causing them harm. Method: We compared the two measures against a "LEAD" (longitudinal evaluation done by experts employing all available data) standard among a sample of 166 drinkers aged 60 years and older in 10 internal medicine clinics. The LEAD standard included a medical record review, a clinical interview and a telephone interview with a collateral informant. We tabulated reasons the LEAD identified subjects as harmful or hazardous drinkers. We also compared the Alcohol Use Disorders Identification Test (AUDIT) and the Short Michigan Alcoholism Screening Test- Geriatric Version (SMAST-G) to the LEAD. Results: Sensitivity and specificity of the ARPS and the shARPS as compared to the LEAD were 93% and 63%, and 92% and 51%, respectively. After minor changes were made in the scoring rules, specificity increased to 66% for both the ARPS and shARPS while sensitivity remained stable. 93% and 91%. Harmful and hazardous drinkers were most often identified because of alcohol use with comorbidities, symptoms, and medication use. Sensitivity and specificity of the AUDIT and the SMAST-G as compared to the LEAD were 28% and 100%, and 52% and 96%, respectively. Conclusions: The ARPS and shARPS are quite sensitive in identifying older drinkers with a spectrum of alcohol use disorders. They are more sensitive than the AUDIT and the SMAST-G in identifying older persons who may be at risk or experiencing harm as a result of their alcohol use and comorbidities. They also provide information on specific risks associated with alcohol use not obtained by other screening measures and may therefore facilitate interventions by busy clinicians to reduce such risks.

Moore AA; Seeman T; Morgenstern H; Beck JC; Reuben DB. Are there differences between older persons who screen positive on the CAGE questionnaire and the Short Michigan Alcoholism Screening Test - Geriatric version? Journal of the American Geriatrics Society 50(5): 858-862, 2002. (33 refs.)

OBJECTIVE: To determine (1) the extent of agreement between the CAGE (acronym for cut down, annoyed by criticism, guilty about drinking, eye-opener drinks) and the Short Michigan Alcoholism Screening Test- Geriatric Version (SMAST-G) in identifying older persons who may have possible alcohol use disorders (AUDs) and (2) whether persons identified as having possible AUDs by each of these screening measures differ in their drinking, demographic, or health-related characteristics. DESIGN: Secondary analysis of a cross-sectional study using data from a self-administered mailed survey sample. SETTING: Three organizations were surveyed: (1) members of the American Association of Retired Persons and, in southern California, (2) managed care enrollees in a large medical group and (3) attendees of a community-based senior health center. PARTICIPANTS: One thousand eight hundred eighty-nine persons aged 55 and older completing a health risk appraisal for older persons (Health Risk Appraisal for the Elderly (HRA-E)). MEASUREMENTS: The HRA-E included items on drinking behaviors (including amount of alcohol use, the CAGE, and the SMAST-G) and health and demographic characteristics. RESULTS: Twenty-six percent of all persons screened positive on the CAGE or the SMAST-G. Fewer than half of all persons screening positive on either the CAGE or the SMAST-G, screened positive on both measures. Among current drinkers, persons screening positive on the SMAST-G alone drank less than persons screening positive on the CAGE alone, and these persons drank less than those screening positive on both the SMAST-G and the CAGE. More men screened positive on the CAGE alone than on the SMAST-G alone. CONCLUSION: Fewer than half of persons screening positive on either the CAGE or the SMAST-G screened positive on both measures, suggesting that these instruments may be capturing different aspects of unsafe drinking. A screening strategy employing both brief measures may identify more AUDs among older persons having differing demographic and health characteristics.

Myerholtz LE; Rosenberg H. Screening DUI offenders for alcohol-problems: Psychometic assessment of the Substance Abuse Subtle Screening Inventory. Psychology of Addictive Behaviors 11(3): 155-165, 1997. (32 refs.)

The present study examined the relationships among 4 alcohol screening instruments (CAGE, MacAndrew Scale, Michigan Alcoholism Screening Test, and Substance Abuse Subtle Screening Inventory [SASSI- 2]). It also assessed the influence of instructional sets to minimize and exaggerate drinking problems on SASSI-2 classification status and scale scores. Fifty-four DUI offenders completed the battery of alcohol screening instruments under standard instructions and then completed the SASSI-2 under 2 additional instructional sets (fake good and fake bad). Moderate correlations for problem drinking status were found among the screening instruments. Internal consistencies for the instruments were generally consistent with what has previously been reported in the literature. In addition, SASSI-2 classifications of participant status and subscale scores differed as a function of instructional set.

Nakashian MR; Moore EA. Identifying Substance Abuse among TANF-eligible Families. Rockville MD: Department of Health and Human Services, 2001. (131 refs.)

This document was prepared to help Temporary Assistance to Needy Families (TANF) officials address the needs of families in their caseloads who are not succeeding, partly because of substance use. The publication is primarily for welfare administrators, who have final responsibility for meeting the goals and requirements of the Personal Responsibility and Work Opportunity Reconciliation Act of 1995 (welfare reform act). The document has for goals: to improve the capacity of welfare agencies, substance abuse treatment providers, job training agencies, and other public and private agencies to identify substance abuse in TANF families; to help these organizations respond better to substance abuse and its related problems among TANF recipients; to help welfare agencies broaden their concept of "identification" to cover multiple activities, including aggressive outreach and marketing campaigns; and to provide welfare officials a framework for creating an organizational culture that makes it safe for welfare recipients to discuss substance abuse. A number of substance abuse screening instruments are described, including the Alcohol Use Disorders Identification Test (AUDIT), CAGE (an acronym for four questions), CAGE-AID (expanded version of the CAGE to include questions about alcohol or drugs), Drug Abuse Screening Test (DAST 10), Michigan Alcoholism Screening Test (MAST), Substance Abuse Subtle Screening Inventory (SASSI), and Addiction Severity Index (ASI)

Nevitt JR; Lundak J; Galardi G. Profile of adolescent alcohol offenders in two rural midwestern counties. Psychological Reports 98(2): 379-384, 2006. (25 refs.)

Screening tools specifically developed for use with adolescents may be more sensitive predictors of relapse or recidivism than self-report inventories typically used to screen adults. 70 adolescents in a program for drunk drivers in two counties in southeastern Nebraska were given both the CRAFFT and the Alcohol Use Disorder Identification Test questionnaires during routine alcohol-dependency evaluations. The Michigan Alcoholism Screening Test was also given to 28 subjects selected at random. 11 boys and 6 girls did not successfully complete the program. Significant correlations obtained for AUDIT scores for both the CRAFFT (r(69) = .65, p < .01) and failure to complete diversion (r(69) = .23, p < .05). Subjects were grouped by age (18 and younger and over 18 years) and by sex. A 2 x 2 analysis of variance for scores on the AUDIT indicated significant main effects for both age (F-1,F-66 = 4.86, p < .05) and sex (F-1.66 = 5.96, p < .01). MAST and CRAFFT scores showed no age or sex differences. The AUDIT might be included in drug and alcohol assessments with similar samples of adolescents.

Nilssen O; Cone H. Screening patients for alcohol problems in primary health care settings. American Journal on Addictions 5(4, Supplement 1): 53-58, 1996. (21 refs.)

This article reviews four screening instruments that have been well validated in primary care environments. The instruments discussed are the CAGE test, the Michigan Alcoholism Screening Test (MAST), the Health Screening Survey (HHS), and the Alcohol Use Disorders Identification Test (AUDIT).

Public Domain

Robin RW; Saremi A; Albaugh B; Hanson RL; Williams D; Goldman D. Validity of the SMAST in two American Indian tribal populations. Substance Use & Misuse 39(4): 601-624, 2004. (47 refs.)

The standardized evaluation of alcoholism and other psychopathologies in minority populations, particularly American Indians, has long been questioned. This study investigated the validity of one of the most commonly applied assessments for alcoholism-the Short Michigan Alcohol Screening Test (SMAST)-in two distinct American Indian tribal groups. We analyzed data collected from 1989 to 1995 from largely community representative samples of 456 Southwestern and 214 Plains Indians ages 21 or older. For comparison, alcohol dependence was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria from a detailed, modified version of the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L). Accuracy of the SMAST was quantified as sensitivity, specificity, likelihood ratios, and the area under the curve for receiver operating characteristics, using the DSM-III-R diagnosis as the reference. The standard SMAST cutoff score of greater than or equal to3 had a demonstrated sensitivity 86% to 95%, but did not perform well in terms of specificity (23%-47%). Significantly higher cutoff scores (greater than or equal to5 for both genders in the Southwestern tribe and 8 and greater than or equal to6 for men and women in the Plains tribe) were required to demonstrate acceptable levels of specificity in both tribes. The findings suggest that the SMAST is not a valid tool to screen for alcohol misuse in these two tribal populations. The highly elevated and different thresholds required from one population to the next and from one gender to the next constitute a significant obstacle to the use of the instrument.

Rumpf HJ; Hapke U; Erfurth A; John U. Screening questionnaires in the detection of hazardous alcohol consumption in the general hospital: Direct or disguised assessment? Journal of Studies on Alcohol 59(6): 698-703, 1998. (36 refs.)

Objective. The aim of this study was to compare the validity of two direct screening questionnaires, the CAGE and MAST, in the detection of hazardous alcohol consumption with a disguised assessment by using the Trauma Scale in a poststratified general hospital sample. Method: Surgical and medical inpatients (N = 1,379) completed the three questionnaires. Hazardous alcohol consumption was defined by criteria derived from a World Health Organization study and assessed using self-reported quantity and frequency. Results: The sensitivity of the Trauma Scale was not significantly different compared to the CAGE and MAST, whereas the direct questionnaires were higher in specificity and overall accuracy (p < .0001). In male surgical patients the detection rate of the Trauma Scale was higher compared to the CAGE (p < .05). Thirteen percent of subjects with hazardous levels of alcohol consumption were detected by the Trauma Scale only. In female surgical patients, the Trauma Scale, when used as an additional tool, does not improve the detection of hazardous drinkers. Conclusions: Because of the low specificity, indirect assessment using a history of trauma cannot be recommended as a screening instrument in a general hospital setting. Despite a high number of false positives, the Trauma Scale may serve as an additional tool in conjunction with direct questionnaires when high sensitivity is desired.

Russell M; Martier SS; Sokol RJ; Mudar P; Jacobson S; Jacobson J. Detecting risk drinking during pregnancy: A comparison of four screening questionnaires. American Journal of Public Health 86(10): 1435-1439, 1996. (21 refs.)

OBJECTIVES. This study investigated the efficacy of screening for risk drinking during pregnancy with two brief questionnaires, TWEAK and T-ACE. Both include an assessment of tolerance based on the number of drinks women report they can hold. METHODS. Subjects were disadvantaged African-American obstetric patients in Detroit, Mich. Traditional alcoholism screens (Michigan Alcohol Screening Test [MAST], CAGE) and the tolerance question were administered (n = 2717); TWEAK and T-ACE were constructed from tolerance and embedded MAST and CAGE items. In a separate sample (n = 1420), only the T-ACE was administered, Periconceptional risk drinking was the gold standard. Screen evaluations were based on receiver-operating characteristic analyses. RESULTS. At the cutpoint of 2, sensitivity/specificity for embedded screens were 91/77 for TWEAK and 88/79 for T-ACE; comparable values for T-ACE alone were 67/86, TWEAK and T-ACE Screened more effectively than CAGE or MAST. CONCLUSIONS. Embedded versions of TWEAK and T-ACE were both highly sensitive to periconceptional risk drinking in this population. Administering T-ACE alone reduced its sensitivity; this suggests that MAST and CAGE administration improves its performance.

Scifres SL. Screening for problematic drinking in women: Validity of the Michigan Alcoholism Screening Test (MAST). Dissertation Abstracts International 63(8): 3937B, 2003

Although problematic drinking in both men and women has far-reaching consequences for society, no adequate screening method for identifying problematic drinking in women has been developed. This study examined gender differences in screening for problematic drinking using the Michigan Alcoholism Screening Test (MAST) and also examined the reliability and validity of a Unigender version of MAST consisting of 20 items. The Unigender MAST demonstrated an internal consistency (alpha = .63), a positive predictive power (.73), and a negative predictive power (.65) in a sample of male and female college students (n = 213). It also demonstrated moderate criterion validity in relation to other measures. It is concluded that the Unigender MAST is promising as a clinically useful tool for alcohol-use disorder screening in a university setting.

Shields AL; Howell RT; Potter JS; Weiss RD. The Michigan Alcoholism Screening Test and its shortened form: A meta-analytic inquiry into score reliability. Substance Use & Misuse 42(11): 1783-1800, 2007. (83 refs.)

Meta-analytic methods provide a framework around which an inquiry into MAST and SMAST score reliability was completed. Of the 470 measurement opportunities observed between 1971 and 2005, 62 (13.2%) were coupled with accurate reliability information. Weighted reliability estimates centered on 80 suggesting that the MAST and SMAST generally produce scores of similar and adequate reliability for most research purposes. However, the variability of internal consistency estimates shows that at times these tools will not produce reliable scores, particularly among female and nonclinical respondents. Multiple regression equations provide practical guidelines to improve reliability estimates for the future use of these instruments.

Snow M; Thurber S; Hodgson JM. An adolescent version of the Michigan Alcoholism Screening Test. Adolescence 37(148): 835-840, 2002. (10 refs.)

Item content of the Michigan Alcoholism Screening Test (MAST) was modified to make it more appropriate for young persons. The resulting test was found to have lower internal consistency than the adult MAST, but the elimination of five items with comparatively poor psychometric properties yielded an acceptable alpha coefficient of .73. A unitary factor model for the adolescent MAST was not confirmed; indeed, the revised test appeared to be factorially complex. Recommendations for further revisions are discussed.

Soderstrom CA; Smith GS; Kufera JA; Dischinger PC; Hebel JR; McDuff DR et al. The accuracy of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test in screening trauma center patients for alcoholism. Journal of Trauma 43(6): 962-969, 1997. (56 refs.)

Objective: To evaluate the accuracy of questionnaire screening instruments to identify lifetime alcohol dependence among trauma center patients. Methods: The study was conducted at a Level I trauma center between September 1994 and November 1996, Patients meeting eligibility requirements (greater than or equal to 18 years old, admission from injury scene, greater than or equal to 2 days of hospitalization, intact cognition) were evaluated for alcohol abuse and dependence. Screening instruments consisted of the CAGE, the Brief Michigan Alcoholism Screening Test, and the Alcohol Use Disorders Identification Test. Screening results were compared with lifetime alcohol dependence diagnoses made using the in-depth Psychoactive Substance Use Disorders section of the Structured Clinical Interview. Accuracy was quantified as sensitivity, specificity, positive/negative predictive values, and receiver operating characteristic curves (used to calculate area under the curve). Results: Of the 1,118 patients studied, lifetime alcohol dependence was diagnosed by Structured Clinical Interview in 397 (35.5%), and abuse was diagnosed in 90 (8.1%) others. The CAGE, was the best predictor of lifetime alcohol dependence, i.e., had the largest area under the curve (93%) and the highest sensitivity (84%), specificity (90%), positive predictive value (82%), and negative predictive value (91%). Among patients testing positive for alcohol, 63% had a lifetime alcohol dependence diagnosis. Conclusion: The CAGE is an efficient screening test to detect alcohol dependence in trauma center populations, It should be used in combination with alcohol testing to identify patients at risk of alcohol use problems.

Stasiewicz PR; Bradizza CM; Maisto SA. Alcohol problem resolution in the severely mentally ill: A preliminary investigation. Journal of Substance Abuse 9: 209-222, 1997. (25 refs.)

Participants (N = 25) with a severe mental illness who were receiving mental health outpatient treatment at a state psychiatric hospital were interviewed regarding the resolution of their alcohol problem. Resolution was defined as abstinence or non-hazardous, consequence-free drinking for a minimum of 1 year. Participants were interviewed regarding their drinking history (Brief Michigan Alcoholism Screening Test and Lifetime Drinking History interview), life events, reasons for change, and factors maintaining change. The results reveal that negative life events and weighing the pros and cons of drinking are more often associated with entry into treatment than positive life events and advice or warnings from others. In addition, resolution occurs with and without a history of alcohol-specific treatment and included both abstinent and non-abstinent drinking outcomes. Although preliminary, these results are consistent with previous research investigating the resolution of alcohol problems in individuals with only a diagnosis of alcohol abuse or dependence. Unique to this population is the finding that control of psychological symptoms was identified as an important maintenance factor during the first 12 months following the resolution date. The limitations of the current study and the implications of these findings for future research investigating processes of change in the severely mentally ill are discussed.

Teitelbaum L; Mullen B. The validity of the MAST in psychiatric settings: A meta-analytic integration. Journal of Studies on Alcohol 61(2): 254-261, 2000. (43 refs.)

Objective. Assessment of alcohol-related problems is essential in psychiatric settings. The Michigan Alcoholism Screening Test (MAST) has been the most commonly evaluated self-report alcohol assessment tool in psychiatric settings. However, due to a large variation in reports of findings and conclusions, a clear understanding of the utility of the MAST in psychiatric settings continues to be elusive. Therefore, the major goals of this investigation were (I)to integrate the available information pertaining to the validity of the MAST when used in psychiatric settings, and (2) to investigate factors that may moderate the performance of the MAST. Method: Using clinically determined alcohol-related diagnosis as a criterion, a meta-analytic integration of nine published studies investigating the criterion validity of the MAST in psychiatric settings is presented. Results: Findings revealed that the MAST is significantly valid when used in psychiatric settings. However, sensitivity estimates were found to be of greater magnitude than specificity estimates. Further, validity estimates of the MAST were found to be higher in psychiatric samples that had a greater proportion of women and in samples that exhibited higher base rates of alcohol-use disorder. Conclusions: Results of this integration support the continued use of the MAST in psychiatric settings as a screening instrument and suggest that those who administer the MAST must be attentive to particular characteristics of respondents.

Teitelbaum LM; Carey KB. Temporal stability of alcohol screening measures in a psychiatric setting. Psychology of Addictive Behaviors 14(4): 401-404, 2000. (17 refs.)

The authors evaluated the test-retest reliability of two common screening instruments administered in a psychiatric setting. The Michigan Alcoholism Screening Test (MAST; M.L. Selzer, 1971) and the CAGE (D. Mayfield, G. McLeod, and P. Hall, 1974) were administered twice, separated by a 1-week interval, to 71 people receiving outpatient psychiatric services and 64 people in the community with no reported history of psychiatric care. The MAST (r=.95) and the CAGE (r=.80) demonstrated adequate test-retest reliability and showed little evidence of variation with respect to degree or direction when administered in a psychiatric setting. Compared to a nonclinical sample, reliability estimates obtained in a psychiatric setting were only slightly lower and more variable. In the psychiatric sample, younger men who had a history of alcohol use disorder were found to be the least reliable. Overall, data suggest that people with severe and persistent mental disorders can offer reliable information about their alcohol-related problems.

Teplin D; Raz B; Daiter J; Varenbut M; Tyrrell M. Screening for substance use patterns among patients referred for a variety of sleep complaints. American Journal of Drug and Alcohol Abuse 32(1): 111-120, 2006. (53 refs.)

Virtually all psychiatric and substance use disorders are associated with sleep disruption. Studies indicate that psychiatric disorders are related closely to chronic insomnia and that psychoactive substances have acute and chronic effects on sleep architecture. Several aspects of sleep are compromised in individuals taking these substances, ranging from difficulty initiating sleep to difficulty maintaining sleep and hypersomnia. Sleep disturbances are apparent in person taking psychoactive drugs or alcohol and have been found to persist long after withdrawing from these drugs. For some, sleep disturbance can be so severe as to reverse treatment success and precipitate relapse to addiction or dependence. There is increasing evidence that primary insomnia without a concurrent psychiatric disorder is a risk factor for later developing substance use disorders. Patients were asked to complete two brief screening tools, the Michigan Alcohol Screening Test and Drug Abuse Screening Test, to examine substance use patterns among patients referred for a variety of sleep complaints in a sleep disorders clinic. We found that patients who demonstrated a variety of sleep complaints were more likely to have alcohol and drug problems than those in the general populations.

Thurber S; Snow M; Lewis D; Hodgson JM. Item characteristics of the Michigan Alcoholism Screening Test. Journal of Clinical Psychology 57(1): 139-144, 2001. (18 refs.)

Items of the Michigan Alcoholism Screening Test (MAST) were individually evaluated regarding disproportional responding. The item with the lowest degree of endorsement (Item 18. related to liver problems) was found to have correspondingly low relationships with other MAST items and with the total score. Weighted items concerned with drug-related arrests were found to detract from the otherwise relatively homogeneous MAST items. Traditional statistical approaches for homogeneity suggest high level internal consistency with the deletion of the aforementioned items. A factor analytic test of homogeneity was confirmed. Recommendations are presented concerning modification of the MAST scoring procedures.

Watkins JP; Eisele GR; Matthews KO. Occupational medical program alcohol screening: Utility of the CAGE and BMAST. Journal of Substance Abuse Treatment 19(1): 51-57, 2000. (23 refs.)

Alcohol consumption is a primary or secondary factor in many work- related accidents, suicides, homicides, violent crimes, and motor vehicle accidents. The absentee rate in alcoholics is 3.8 to 8.3 times greater than that for nonalcoholic workers. The purpose of this research was to evaluate the effectiveness of two interview questionnaires-the Brief Michigan Alcoholism Screening Test (BMAST) and the CAGE (cut down, annoyed by criticism, guilty about drinking, and eye-opener drinks). The validity of the BMAST and the CAGE as screening tools for alcohol problems has been verified in a number of nonworkplace settings. If they prove to be as effective for screening workers in an occupational medical setting, follow-up definitive diagnoses could result in earlier detection of alcohol problems and allow prompt intervention. Positive outcomes could include a safer workplace, less absenteeism, improved worker productivity, and a reduction in personal and family problems caused by drinking.

Westermeyer J; Yargic I; Thuras P. Michigan Assessment-Screening Test for Alcohol and Drugs (MAST/AD): Evaluation in a clinical sample. American Journal on Addictions 13(2): 151-162, 2004. (44 refs.)

In this study, we sought to evaluate a modification of the Michigan Alcohol Screening Test designed to include problems associated with other drug abuse/dependence besides alcohol. Scores of the lifetime Michigan Assessment-Screening Test/Alcohol-Drug (MAST/AD) were compared to other lifetime measures of substance abuse and dependence and to psychiatric scales reflecting current or recent symptoms. Two university medical centers with alcohol-drug programs located within departments of psychiatry hosted 520 patients with alcohol-drug-related diagnoses. Patients completed their own MAST/AD using a paper-and-pencil format. Based on interviews with the patient, a research associate rated the patients' substance-related problems on the Minnesota Substance Abuse Problem Scale (M-SAPS) and obtained information on lifetime treatment for substance abuse. An addictions psychiatrist determined abuse or dependence and made a current diagnosis of alcohol abuse/dependence only, drug abuse/dependence only, and alcohol plus drug abuse/dependence. The MAST/AD was highly correlated with the M-SAPS and several other measures of substance abuse morbidity. Patients with alcohol-only and drug-only diagnoses did not differ from one another on the MAST/AD, although both groups had lower scores than those with alcohol plus drug diagnoses. Current psychosocial morbidity as assessed by the patient and the psychiatrist was associated with the MAST/AD, although less strongly than with lifetime substance abuse measures. The lifetime MAST/AD demonstrates reliability as a severity measure for alcohol and/or or drug abuse. With minor modification, this standard measure can be expanded from alcohol diagnoses to all substance diagnoses. This study in a clinical population did not demonstrate its utility as a screening instrument; additional work is needed to reveal its utility for this purpose.

White RJ; Ackerman RJ; Caraveo LE. Self-identified alcohol abusers in a low-security federal prison: Characteristics and treatment implications. International Journal of Offender Therapy and Comparative Criminology 45(2): 214-227, 2001. (37 refs.)

One hundred fifteen male inmates arriving at a low-security federal correctional institution in 1998 completed the Michigan Alcohol Screening Test (MAST) as part of a standard psychological intake battery that included a background questionnaire, the Million Clinical Multiaxal Inventory Version 3 (MCMI-III), and the Conflict Tactics Scale. The majority of inmates screened positive for alcohol problems on the MAST(61%). Self-identified alcohol abusers were more likely to evidence antisocial personality patterns anxiety disorders, domestic violence histories, and other substance misuse. Roughly 1 in 4 (24%) showed a combination of antisocial personality and low anxiety on the MCMI, suggestive of primary psychopathic disorder: The findings suggest that low-security inmates who screen positive on the MAST often present with other substance use problems, personality pathology, and domestic violence histories that potentially inform treatment efforts by mental health professionals in federal prisons.

Wilson D. Routine screening tests for alcoholism. South African Medical Journal 89(9): 949-951, 1999. (0 refs.)

In a column the "test of the month", screening tests for alcohol problems are reprinted -- the CAGE, the Brief MAST, The Trauma Scale and the AUDIT. The diagnostic criteria for Alcohol Dependence and Alcohol Abuse are also highlighted.