questionnaire

Description: 
NIAAA guide for practitioners on alcohol screening and brief interventions for youth
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Description: 
A website that explains the 5 A's for tobacco cessation.
Source: 
US Department of Health and Human Services
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Michigan Alcoholism Screening Test (MAST)

Description: 
The Michigan Alcoholism Screening Test (MAST) is a 25-item questionnaire used to screen for alcohol abuse and dependence.

1. Do you enjoy a drink now and then? (Introductory -- no points)

2. Do you feel you are a normal drinker (by normal, we mean do you drink less than or as much as most other people)? (2)

3. Have you ever awakened the morning after some drinking the night before and found that you could not remember a part of the evening? (2)

4. Does your wife, husband, parent, or other relative ever worry or complain about your drinking? (1)

5. Can you stop drinking without a struggle after 1 or 2 drinks? (1)

6. Do you ever feel bad about your drinking? (1)

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Alcohol Use Disorders Identification Test (AUDIT)

Description: 
The 10-question Alcohol Use Disorders Identification Test (AUDIT) was developed by the World Health Organization (WHO) specifically for primary care settings as a screen for detecting at-risk or hazardous drinking. A shorter version of the AUDIT also is used in primary care and consists of the first 3 questions of the AUDIT. Note: The AUDIT manual from WHO suggests adjusting Question 3 based on the size of the standard drink in the country where it will be used. The U.S. standard drink is now 14 grams, therefore many clinicians are now using 4 drinks rather than 6 drinks in Question 3; alternatively, have the patient refer to a diagram showing the standard drink size.

1. How often do you have a drink containing alcohol?

___ never (0 point)

___ less than monthly / monthly (1 point)

___ 2-4 times/month (2 points)

___ 2-3 times/week (3 points)

___ 4 or more times/week (4 points)

2. How many standard drinks containing alcohol do you have on a typical day drinking?

___ 1 or 2 (0 point)

___ 3 or 4 (1 point)

___ 5 or 6 (2 points)

___ 7 or 9 (3 points)

___ 10 or more (4 points)

3. How often do you have six or more drinks on one occasion?

___ never (0 point)

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