The Short Michigan Alcohol Screening Test (SMAST) is a 13-item yes/no self-report questionnaire that screens adults for signs of a possible alcohol use problem. Condensed from the original 25-item Michigan Alcoholism Screening Test, it asks about drinking-related consequences across relationships, work, health, and help-seeking to flag people who may need a fuller assessment.
Why healthcare providers use the SMAST
- Fast, structured screening. Thirteen yes/no items give a standardized read on drinking-related problems in a couple of minutes, without a lengthy interview.
- Broad view of consequences. The questions span relationships, work, health, and help-seeking, so the screen reflects how drinking affects daily life rather than volume alone.
- A shared reference point. A single score gives the patient and care team a common starting point for a conversation about alcohol use.
- Low burden. Because it is short and self-administered, it fits easily into intake without adding much to the patient's workload.
Which settings use the SMAST?
- Primary care. Used at intake or annual visits to identify patients whose drinking may warrant a closer look.
- Behavioral health and addiction services. Applied during assessment to help gauge the likelihood of an alcohol problem.
- Hospital and general medical settings. Helps identify alcohol-related risk among patients presenting for other concerns.
- Telehealth. As a short self-report screen, it is easy to complete before a virtual visit.
What does the SMAST measure?
The SMAST measures self-reported consequences and perceptions associated with drinking rather than the amount a person drinks. Its 13 items ask about problems that tend to accompany an alcohol use disorder, grouped into a few broad domains:
- Self-perception of drinking. Whether the person views their own drinking as normal and whether others have expressed concern.
- Social and interpersonal impact. Effects on family, friendships, and social or occupational functioning.
- Health and safety consequences. Physical, legal, or safety problems the person links to their drinking.
- Help-seeking and control. Past efforts to get help, attend support groups, or cut down on drinking.
Scoring the SMAST
- Number of items. 13 questions.
- Per-item scale. Each item is answered yes or no, and a response indicating a problem scores 1 point. Most items count a yes answer, while a few are reverse-scored so that a no answer scores the point.
- Total score range. 0 to 13.
- Score direction. Higher scores indicate more drinking-related problems and a greater likelihood of an alcohol use problem.
The SMAST is a screening tool, not a diagnosis. Published cutoffs vary slightly across sources: the original scoring treats a score of 3 or more as suggestive of a probable alcohol problem, while some clinical settings apply a more conservative threshold of 4 or more before recommending a full assessment. A positive screen guides clinical decision-making and prompts follow-up rather than confirming a disorder on its own.
| SMAST score | Interpretation | Suggested next step |
|---|---|---|
| 0-1 | No indication of an alcohol problem | Monitor |
| 2 | Borderline, possible alcohol problem | Consider further assessment |
| 3-13 | Suggests a probable alcohol problem | Consider further assessment |
Best practices for administration
- Explain the purpose. Tell patients the questions screen for alcohol-related concerns so they understand why they are being asked.
- Support honest answers. Ask in a private, nonjudgmental way, since accuracy depends on candid responses.
- Set a time frame. Clarify the period the questions cover, as the SMAST traditionally asks about lifetime experience with drinking problems.
- Treat it as a screen. Use a positive result to open a conversation and consider further assessment, not as a standalone diagnosis.
- Pair with context. Review results alongside history, other screens, and clinical judgment before drawing conclusions.
How Zentake helps with the SMAST
- Automatic scoring. Zentake totals the SMAST on submit, so there is no hand-tallying.
- Before the visit. At substance use practices, patients complete it from home on any device, so the clinician starts informed.
- HIPAA compliant. Data is encrypted, with a signed BAA on every plan.
References
Selzer ML, Vinokur A, van Rooijen L. A self-administered Short Michigan Alcoholism Screening Test (SMAST). Journal of Studies on Alcohol, 1975. This is the primary validation paper describing the 13-item scale and its original scoring.
For scoring and interpretation guidance, see the SMAST summary compiled by San Mateo County Health, which documents the 13-item yes/no format, the 0 to 13 range, and commonly used cutoffs.
Last updated: August 2026