EXPERT WITNESS: The MAST: Still an excellent instrument

By Michael G. Brock Determining what constitutes alcohol or drug dependence in the modern age can be a bit murky, especially since problems tend to emerge at a much earlier stage today than when I began doing treatment in the 1970s. In those days you could have five or six drunk driving arrests and still have a driver's license. People usually went for treatment because they were suffering medical consequences, such as liver or heart disease, pancreatitis, bleeding ulcers, or other such symptoms of advanced alcohol/drug addiction. The next most frequent reason for seeking treatment in those days was that the person's job was on the line. After that came impending divorce, and way down the line, legal problems -- unless, of course, you were involved in a traffic fatality while drunk, in which the legal problems quickly became the primary issue. It has never been easy for alcoholics/addicts to admit they had a problem, but when they realized their lives or their livelihood were threatened because of their drinking/drug use, they were generally more receptive than people who are still having fun with substances. How do you reach someone who believes his or her only mistake was getting caught drinking and driving if they don't see problems in any other areas of their lives? These problems may already exist at some level, but they are nowhere near becoming a crisis, so early stage addicts can be much harder to reach. The MAST (Michigan Alcohol Screening Test) is a useful tool for this purpose because the client's answers, even if he is being defensive and evasive, can help him see that what he considers minor now, is on the way to becoming major. The test consists of 24 questions of self-report, which explore whether the client thinks he has a problem, and if he is experiencing: 1. Medical consequences of addiction such as alcohol related illness or injury. 2. Withdrawal symptoms, psychiatric treatment and/or hospitalization for the above. 3. Psychosocial problems, such as difficulty on the job or at work, 4. Conflict/estrangement with/from family or friends. 5. violent altercations. 6. Or arrests for any alcohol or drug related behavior. 7. Finally, and perhaps most importantly, the MAST explores whether the client has any degree of loss of control. This is really the most critical factor in determining whether someone has a problem with substance dependency. Loss of control is generally subtle; addiction does not begin with one sleeping under a freeway overpass covered in newspapers. It starts slowly and proceeds to the point where the frequency and amount of consumption affect the person's ability to: a. Choose if and when to use their drug of choice. b. Predict with certainty his or her behavior once he or she begins to drink or use drugs. If a person cannot always decide if and when to drink/use, or is not always able to predict his or her behavior after the first drink/drug, he is suffering from some degree of loss of control, hence addiction. The insidiousness of this disease is that it is very difficult for the client to recognize, accept, and treat his or her condition until the addiction process is well underway. Once it begins, loss of control is progressive, and, despite all the efforts of the affected party to control his or her drinking/drug use, or to control their behavior (like not getting behind the wheel of a car when one has been drinking), problems increase in frequency and severity. If we can help the client see this before their life or the lives of others have been permanently altered by their condition, we have done both the client and society a great service and prevented much future suffering for all affected directly or tangentially by one person's addiction. The MAST is still a helpful tool in assisting clients to realize that, though their symptoms may be mild now, there will inevitably be much suffering ahead unless they are able to accept the choice of abstinence. Once the progression of substance dependence has begun, the only other possibility is the increasingly severe consequences of addiction. Michigan Alcohol Screening Test 1. Do you feel that you are a normal drinker? Yes (0), No (2). 2. Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of that evening? Yes (0), No (2). 3. Do you family or friends ever worry or complain about your drinking? Yes (0), No (1). 4. Can you always stop drinking without a struggle after one or two drinks? Yes (0), No (2). 5. Do you ever feel bad about your drinking? Yes (0), No (1). 6. Do your friends or relatives think that you're a normal drinker? Yes (0), No (2). 7. Are you always able to stop drinking when you want to? Yes (0), No (2). 8. Have you ever attended a meeting of Alcoholics Anonymous (AA) or any other group concerned about drinking? Yes (0), No (5). 9. Have you ever gotten into fights when drinking? Yes (0), No (1). 10. Has drinking ever created problems with you and your family or friends? Yes (0), No (2). 11. Have your friends or any family member ever gone to anyone for help about your drinking? Yes (0), No (2). 12. Have you ever lost a job or been suspended from school because of your drinking? Yes (0), No (2). 13. Have you ever gotten into trouble at work or school because of drinking? Yes (0), No (2). 14. Have you ever lost friends because of drinking? Yes (0), No (2). 15. Have you ever neglected your obligations, your family, your work or your schoolwork for two or more days in a row because you were drinking? Yes (0), No (2). 16. Do you drink before noon? Yes (0), No (1). 17. Have you ever been told you have liver trouble or other medical consequences of alcohol or drug abuse? Yes (0), No (2). 18. Have you ever had delirium tremens (DTs), severe shaking, heard voices, or seen thinks that were not there after heavy drinking? Yes (0), No (5). 19. Have you ever gone to anyone for help about your drinking? Yes (0), No (5). 20. Have you ever been to a hospital emergency room because of your drinking? Yes (0), No (5). 21. Have you ever been a patient in a psychiatric hospital or psychiatric unit in a general hospital where drinking was part of the problem? Yes (0), No (2). 22. Have you ever been to a mental health clinic, gone to a doctor, social worker, counselor, or clergyman for help with an emotional problem in which drinking played a part? Yes (0), No (2). 23. Have you ever been arrested, other than drinking and driving, for drinking or other substance related behavior (drunk and disorderly, MIP, possession of MJ, etc.)? Yes (0), No (2). 24. Have you ever been arrested for drunk driving or driving after drinking? Yes (0), No (2). ____________ Total Score: RATING * 0-3 Points Low Risk * 4-9 Points High risk for problem drinking * 10 or more points Alcoholism ---------- Michael G. Brock, MA, LLP, LMSW, is a forensic mental health professional in private practice at Counseling and Evaluation Services in Wyandotte. He has worked in the mental health field since 1974, and has been in full-time private practice since 1985. The majority of his practice in recent years relates to driver license restoration and substance abuse evaluation. He may be contacted at Michael G. Brock, Counseling and Evaluation Services, 2514 Biddle, Wyandotte, 48192; (313) 802-0863, fax/phone (734) 692-1082; email: michaelgbrock@ comcast.net. Published: Wed, Sep 21, 2011