ABPM Addiction Medicine cheat sheet

DSM-5-TR substance use disorder (SUD) requires ≥2 of 11 criteria within 12 months; severity: mild 2–3, moderate 4–5, severe ≥6.

Tolerance and withdrawal are not counted toward SUD criteria when the substance is taken as prescribed and the physiologic response is expected (e.g., prescribed opioid, beta-blocker).

Screening cutoffs: AUDIT-C positive at ≥4 (men) or ≥3 (women); AUDIT ≥8 indicates hazardous use, ≥16 suggests likely dependence; DAST-10 score ≥3 indicates moderate problems.

Brief intervention (5 A's: Ask, Advise, Assess, Assist, Arrange) reduces unhealthy alcohol use; number needed to treat ≈ 8–12 for at-risk drinkers.

Withdrawal timelines: alcohol 6–24 h (seizures 12–48 h, delirium tremens 48–96 h); opioid 8–24 h peak 36–72 h; benzodiazepine 1–4 days (long-acting) to 1–3 weeks.

CIWA-Ar guides alcohol withdrawal treatment; scores ≥8–10 generally trigger symptom-triggered benzodiazepine dosing; thiamine 100 mg IV/PO before glucose to prevent Wernicke encephalopathy.

Medication for opioid use disorder reduces mortality: methadone and buprenorphine lower all-cause mortality by roughly 50% or more versus no medication; naltrexone requires 7–10 days opioid-free.

Recovery is a process of sustained remission; DSM-5 early remission = 3–12 months without criteria (except craving), sustained remission = >12 months.

Motivational interviewing uses OARS (Open questions, Affirmations, Reflections, Summaries) and targets change talk; MI is associated with small-to-moderate effect sizes for substance outcomes.

Alcohol withdrawal seizure risk peaks 12–48 h; delirium tremens carries mortality up to 5% untreated and is treated with benzodiazepines, not antipsychotics alone.

Alcoholic hepatitis: Maddrey discriminant function ≥32 indicates severe disease; corticosteroids (prednisolone 40 mg × 28 days) improve short-term survival in selected patients.

Opioid overdose triad: pinpoint pupils, respiratory depression, and decreased consciousness; naloxone 0.4–2 mg IV/IM/IN, repeat every 2–3 min; duration may be shorter than the opioid, requiring observation.

Opioid overdose reversal does not precipitate prolonged withdrawal in dependent patients at low doses; titrate to restore respiration, not full arousal.

Stimulant intoxication: hyperthermia, tachycardia, hypertension, agitation, and seizures; treatment is supportive with benzodiazepines for agitation and cooling for hyperthermia.

Wernicke encephalopathy triad: ophthalmoplegia, ataxia, and confusion; only about 16% of patients present with all three, so treat empirically with thiamine.

Cannabis hyperemesis syndrome: recurrent vomiting with compulsive hot bathing; resolves with cannabis cessation; capsaicin cream is a supportive adjunct.

Infectious complications: endocarditis (especially right-sided with injection drug use), hepatitis C, and HIV; offer HCV treatment and HIV PrEP regardless of ongoing substance use.

Neonatal opioid withdrawal syndrome: Finnegan or modified Finnegan scoring guides treatment; first-line pharmacotherapy is morphine or methadone, with nonpharmacologic care (rooming-in, breastfeeding) as foundation.

Nicotine: combination NRT (patch plus short-acting) is more effective than single NRT; varenicline is the most effective single agent; bupropion is an alternative.

First-line smoking cessation pharmacotherapy should be offered to all smokers willing to quit; brief advice alone yields quit rates of about 2–3% per attempt.

Unhealthy alcohol use: FDA-approved medications are naltrexone (oral or long-acting injectable), acamprosate (best if hepatic impairment; requires normal renal function), and disulfiram (supervised, motivated patients).

Naltrexone is contraindicated with concurrent opioid use or acute hepatitis/liver failure; check LFTs; acamprosate is dosed 666 mg three times daily.

Benzodiazepine deprescribing: taper 5–10% every 2–4 weeks (slower, 12.5% every 2 weeks or less, for long-term users); abrupt discontinuation risks seizures.

Prescription drug monitoring programs (PDMPs) should be checked before initiating controlled substances and at least every 3 months for chronic opioid therapy.

Opioid prescribing: co-prescribe naloxone for patients on ≥50 MME/day or with other overdose risk factors; avoid concurrent benzodiazepines when possible.

Cannabis use disorder has no FDA-approved medication; treatment is behavioral (CBT, MET, contingency management).

Stimulant use disorder: contingency management is the most effective intervention; no FDA-approved pharmacotherapy exists.

Codependency describes patterns where family members enable substance use by shielding the person from consequences; it is a descriptive concept, not a DSM diagnosis.

CRAFT (Community Reinforcement and Family Training) increases treatment entry for the substance user (roughly 60–70% engage in treatment) and improves family functioning.

Al-Anon and Nar-Anon are mutual-help groups for family members; attendance is associated with reduced family distress.

Enabling behaviors include providing money for substances, covering legal or employment consequences, and minimizing the problem; reducing enabling is a core family intervention target.

Family involvement in treatment (e.g., Multidimensional Family Therapy, Functional Family Therapy) improves adolescent SUD outcomes.

Children of parents with SUD have elevated risk for adverse childhood experiences, mental health disorders, and later SUD; screening for ACEs and offering support are indicated.

Screening family members for their own unhealthy use is warranted; household smoking and alcohol availability are modifiable environmental risk factors.

Behavioral couples therapy for SUD improves both substance outcomes and relationship satisfaction compared with individual therapy.

Family members should be educated that relapse is common and is a clinical event, not evidence of moral failure; this framing reduces shame and improves engagement.