in health care, education, workplace and
criminal justice settings.^193
Clinical Utility. The ADS has been found to be
a reliable and valid instrument.^194 In one study,
the ADS identified accurately 88 percent of
individuals based on DSM criteria.^195 Using a
cut-off score of eight, the ADS had a sensitivity
rate of 78 percent and a specificity rate of 88
percent among a sample of homeless women in
treatment.^196 When examined in an inmate
population, the ADS was found to have good
test-retest reliability and identified accurately
79.6 percent of inmates with regard to their
addiction status; however, the instrument’s
sensitivity in this population was found to be
low (51.0 percent) relative to its specificity (95.7
percent).^197
The Michigan Alcoholism Screening Test
(MAST)
The Michigan Alcoholism Screening Test,
originally developed in 1971, is one of the most
well-known assessment tools for identifying
lifetime symptoms of addiction involving
alcohol.^198 It consists of 25 yes/no questions
concerning drinking behavior and alcohol-
related problems.^199 The instrument can be self-
administered or administered in an interview
format. The entire process, including scoring,
takes less than 15 minutes and training is not
required.^200
There also is a 13-item version, referred to as
SMAST, for Short Michigan Alcoholism
Screening Test.* 201 The SMAST consists of
yes/no items and affirmative answers are worth
one point each. Generally a score of three
indicates respondents are risky alcohol users and
a score of four or higher indicates potential
addiction involving alcohol.^202
- Other variations of the instrument exist, including a
10-item version called the Brief MAST, a version
that incorporates other drug diagnoses called MAST
for Alcohol and Drugs (AD) and a version for
geriatric patients (MAST-G). Since these variations
are not used as commonly as MAST and SMAST,
they are not elaborated upon here.
The MAST is not copyrighted and there is no fee
for its use, however there is a small fee to obtain
a copy of the instrument from the developers.^203
There is no cost for using the SMAST.^204Populations and Settings Served. The MAST
and SMAST can be used in a wide variety of
adolescent and adult populations and in both
clinical and research settings.^205 SMAST has
demonstrated strong reliability among Hispanic
individuals^206 and has been well validated in
primary care settings.^207 Since the MAST is
better at detecting more severe rather than less
advanced risky alcohol use or addiction, it may
not be as useful among college students.^208Clinical Utility. Studies have found the MAST
to be valid^209 and reliable.^210 Among adult
outpatients, the SMAST identified 82 percent of
individuals with lifetime addiction involving
alcohol and 100 percent of those with current
addiction. The corresponding specificity rates
were 96 and 85 percent, respectively.^211
However, another study using the same cut-off
score found that the SMAST identified
accurately only 48 percent of individuals with
addiction involving alcohol and 95 percent of
individuals without addiction.^212 While the
SMAST has demonstrated good test-retest
reliability in inmate populations, its validity in
this group is less strong; in one study, the
SMAST identified accurately 100 percent of
inmates with addiction involving alcohol, but
66.3 percent of inmates without addiction were
misidentified as having addiction.^213Drug-Specific Screening and
Assessment Tools
The Drug Abuse Screening Test (DAST)
The Drug Abuse Screening Test was developed
in 1982 to screen for lifetime risky drug use
(excluding nicotine and alcohol) and assess
addiction in adult populations.^214 There are four
variations of the DAST: a 28-item, a 20-item, a
10-item and a 27-item questionnaire--the last is
intended for adolescents.^215