HomeMy WebLinkAboutLPD MAST Questionnaire_2022MAST SCORE: __________
NAME: ___________________________________ DATE: ___________________
DIRECTIONS: Please answer the following questions as honestly as you can. Write
“Yes” or “No” in the left hand margin.
2a ______ Do you feel you are a normal drinker?
2 ______ Have you ever done something you couldn’t remember while you were
drinking?
1 ______ Does your spouse (parents or girlfriend/boyfriend) ever worry or
complain about your drinking?
2a ______ Can you stop drinking without a struggle after one or two drinks?
1 ______ Do you ever feel guilty about your drinking or something you’ve done
while drinking?
2a ______ Do your friends or relatives think you are a normal drinker?
5 ______ Have you ever attended or been instructed to attend a meeting of
Alcoholics Anonymous?
1 ______ Have you ever gotten into physical fights while drinking?
2a ______ Are you always able to stop drinking when you want to?
2 ______ Has drinking ever created problems between you and your spouse
(girlfriend/boyfriend)?
2 ______ Has your spouse or any other family member ever gone to anyone for
help regarding your drinking?
2 ______ Have you ever lost friends because of your drinking?
2 ______ Have you ever gotten into trouble at work because of drinking?
2 ______ Have you ever lost a job because of drinking?
2 ______ Have you ever neglected your obligations, your family or your work for
two or more days in a row because of drinking?
1 ______ Do you ever drink in the morning?
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2 ______ Have you ever been told you have liver trouble or that you ought to cut
down on your drinking?
2b ______ Have you ever had DT’s, severe shaking, heard voices or seen things
that weren’t there after heaving drinking?
5 ______ Have you ever gone to anyone for help about your drinking?
5 ______ Have you ever been in a hospital because of drinking or a drinking
related accident?
2 ______ Have you ever been a patient in a psychiatric hospital or mental health
ward where drinking was a part of the problem?
2 ______ Have you ever been seen at a psychiatric or mental health clinic, gone
to a doctor, social worker or clergyman for help with an emotional
problem in which drinking played a part?
2c ______ Have you ever been arrested for drunk or impaired driving? How many
times? _____
2c ______ Have you ever been arrested for any other offense because of drunk
behavior that you probably wouldn’t have done had you not been
drinking? How many times? _____