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ABPM Addiction Medicine study materials
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ABPM Addiction Medicine practice questions

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Question 1Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A patient presents 8 hours after their last drink with tremor, diaphoresis, and a CIWA-Ar score of 12. Which medication class is first-line for managing this withdrawal syndrome?

  1. Opioid antagonists
  2. Benzodiazepines Correct answer.
  3. Beta-blockers alone
  4. Antipsychotics

Explanation

Benzodiazepines are first-line for alcohol withdrawal because they restore GABA-A activity and reduce the risk of seizures and delirium tremens. They are titrated to symptom scores rather than given on a fixed schedule in most protocols.

Question 2Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which medication is approved for maintenance treatment of opioid use disorder and also carries a boxed warning for QT prolongation?

  1. Buprenorphine
  2. Methadone Correct answer.
  3. Naltrexone
  4. Acamprosate

Explanation

Methadone is a full opioid agonist used for maintenance and carries a boxed warning for QT prolongation and torsades de pointes. Buprenorphine is a partial agonist without that specific cardiac warning, and naltrexone and acamprosate are not opioid maintenance agonists.

Question 3Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A patient with opioid use disorder is being started on buprenorphine. Which finding best indicates that the patient is in sufficient withdrawal to safely initiate treatment?

  1. Recent use of a long-acting opioid within 2 hours
  2. Normal vital signs and no symptoms
  3. A COWS score in the moderate range with objective signs Correct answer.
  4. Pinpoint pupils and drowsiness

Explanation

Buprenorphine is a partial agonist with high affinity, so it is started when the patient is in moderate withdrawal (typically COWS 8-12 or higher) to avoid precipitated withdrawal. Objective signs such as yawning, rhinorrhea, and piloerection support readiness.

Question 4Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which statement best reflects the recommended approach to treating alcohol use disorder in a patient who continues to drink heavily?

  1. Medication should be withheld until the patient achieves abstinence
  2. Naltrexone can reduce heavy drinking even without complete abstinence Correct answer.
  3. Disulfiram is preferred as first-line therapy
  4. Psychosocial therapy alone is contraindicated

Explanation

Naltrexone reduces heavy drinking days and craving and can be effective even when patients are not fully abstinent. Treatment goals should be individualized and medications offered alongside behavioral therapy.

Question 5Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A patient is found unresponsive with a respiratory rate of 6 and pinpoint pupils. After airway support, which medication should be administered?

  1. Naloxone Correct answer.
  2. N-acetylcysteine
  3. Flumazenil
  4. Atropine

Explanation

The triad of decreased consciousness, respiratory depression, and pinpoint pupils indicates opioid toxicity, and naloxone is the opioid antagonist of choice. Repeat dosing or infusion may be needed for long-acting opioids.

Question 6Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which screening instrument is specifically validated for detecting unhealthy alcohol use in primary care?

  1. PHQ-9
  2. GAD-7
  3. MMSE
  4. AUDIT-C Correct answer.

Explanation

The AUDIT-C is a brief, validated alcohol screening tool that identifies hazardous drinking and is widely used in primary care. The PHQ-9 and GAD-7 screen for depression and anxiety, and the MMSE assesses cognition.

Question 7Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which finding is most consistent with alcohol withdrawal delirium (delirium tremens)?

  1. Normal mental status with mild anxiety
  2. Bradycardia and hypothermia
  3. Constricted pupils and sedation
  4. Disorientation with tachycardia and tremor Correct answer.

Explanation

Delirium tremens involves altered sensorium and autonomic hyperactivity such as tachycardia, tremor, and diaphoresis, typically 48-96 hours after the last drink. It is a medical emergency with significant mortality if untreated.

Question 8Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A patient with alcohol use disorder is being evaluated for thiamine deficiency. Which presentation is most characteristic of Wernicke encephalopathy?

  1. Choreiform movements and dementia
  2. Ascending paralysis and areflexia
  3. Ataxia, ophthalmoplegia, and confusion Correct answer.
  4. Unilateral weakness and aphasia

Explanation

Wernicke encephalopathy classically presents with the triad of ataxia, oculomotor abnormalities, and confusion due to thiamine deficiency. Untreated, it can progress to Korsakoff syndrome with persistent memory impairment.

Question 9Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which medication is a first-line option for smoking cessation that acts as a partial nicotinic agonist?

  1. Varenicline Correct answer.
  2. Nortriptyline
  3. Clonidine
  4. Bupropion

Explanation

Varenicline is a partial agonist at nicotinic acetylcholine receptors and is among the most effective single agents for smoking cessation. Bupropion and nortriptyline are non-nicotinic antidepressants, and clonidine is a second-line adjunct.

Question 10Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A patient with cocaine use disorder presents with agitation, hypertension, and chest pain. Which initial management step is most appropriate?

  1. Start methadone maintenance
  2. Give naloxone empirically
  3. Provide supportive care with benzodiazepines for agitation Correct answer.
  4. Administer a beta-blocker as first-line therapy

Explanation

Cocaine toxicity is managed with supportive care, and benzodiazepines are used to control agitation, hypertension, and reduce the risk of seizures. Beta-blockers are avoided initially because of concerns about unopposed alpha stimulation.

Question 11Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which statement about contingency management is best supported by evidence?

  1. It relies primarily on aversive punishment
  2. It requires long-term residential placement
  3. It provides tangible rewards for verified abstinence or target behaviors Correct answer.
  4. It is ineffective for stimulant use disorder

Explanation

Contingency management reinforces desired behaviors such as verified abstinence with tangible rewards and has strong evidence for stimulant use disorder. It is a behavioral intervention that can be delivered in outpatient settings.

Question 12Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which medication is used for maintenance treatment of alcohol use disorder by reducing craving and is renally excreted without hepatic metabolism?

  1. Acamprosate Correct answer.
  2. Naltrexone
  3. Disulfiram
  4. Topiramate

Explanation

Acamprosate supports abstinence by reducing craving and is eliminated renally, making it a reasonable choice in patients with significant hepatic impairment. Naltrexone and disulfiram involve hepatic metabolism.

Question 13Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A patient on methadone maintenance reports palpitations. Which evaluation is most appropriate given the medication's known risks?

  1. Order a urine porphyrin screen
  2. Check a serum acetaminophen level
  3. Obtain an electrocardiogram to assess the QTc interval Correct answer.
  4. Perform an exercise stress test immediately

Explanation

Methadone can prolong the QT interval and cause torsades de pointes, so an ECG to assess QTc is appropriate when symptoms or risk factors are present. Electrolytes such as potassium and magnesium should also be checked.

Question 14Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which feature distinguishes a substance-induced mood disorder from a primary mood disorder?

  1. There is a family history of bipolar disorder
  2. Symptoms persist for more than one year after cessation
  3. Symptoms occur in temporal association with intoxication or withdrawal Correct answer.
  4. The patient has never received psychiatric treatment

Explanation

A substance-induced mood disorder is temporally linked to intoxication or withdrawal and typically resolves with sustained abstinence. Primary mood disorders are not fully explained by substance use and often persist beyond that window.

Question 15Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which intervention is recommended for a patient with alcohol use disorder and advanced cirrhosis who is being evaluated for pharmacotherapy?

  1. Disulfiram is first-line in cirrhosis
  2. Acamprosate may be preferred due to hepatic sparing Correct answer.
  3. Naltrexone is preferred because it is renally cleared
  4. All alcohol medications are contraindicated

Explanation

Acamprosate is renally eliminated and does not require hepatic metabolism, making it a reasonable choice in advanced liver disease. Naltrexone carries hepatotoxicity concerns, and disulfiram is contraindicated in significant hepatic impairment.

Question 16Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which of the following best describes the mechanism of disulfiram?

  1. It enhances GABA-A receptor activity
  2. It blocks opioid receptors
  3. It inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation Correct answer.
  4. It is a partial nicotinic agonist

Explanation

Disulfiram inhibits aldehyde dehydrogenase, so drinking alcohol leads to acetaldehyde accumulation with flushing, nausea, and tachycardia. This aversive reaction supports abstinence when adherence is supervised.

Question 17Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A patient with opioid use disorder asks about naltrexone. Which prerequisite is most important before starting oral naltrexone?

  1. The patient must be fully opioid-free for an adequate period Correct answer.
  2. The patient must be currently taking buprenorphine
  3. The patient must have active severe pain
  4. The patient must be in acute opioid withdrawal at the time of dosing

Explanation

Naltrexone is an antagonist that will precipitate severe withdrawal if opioids are still present, so patients must be opioid-free for an adequate interval first. The required interval depends on the opioid's half-life.

Question 18Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which finding most strongly suggests that a patient's alcohol use has progressed to a severe use disorder?

  1. A family history of alcohol use disorder
  2. A single episode of binge drinking
  3. Tolerance, withdrawal, and continued use despite harm Correct answer.
  4. Drinking on weekends with friends

Explanation

Severity in DSM-5 is based on the number of criteria met, and tolerance, withdrawal, and continued use despite harm are core indicators of a more severe disorder. Isolated binge drinking or family history alone does not establish severity.

Question 19Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which statement about neonatal opioid withdrawal is accurate?

  1. It is unrelated to maternal opioid exposure
  2. It is assessed with tools such as the Finnegan scale and managed supportively with medication when severe Correct answer.
  3. It is diagnosed only by maternal self-report
  4. It requires immediate treatment with naloxone in all cases

Explanation

Neonatal opioid withdrawal is assessed with standardized tools such as the Finnegan scale and managed with supportive care and, when severe, medications such as morphine or buprenorphine. Naloxone is not used to treat withdrawal.

Question 20Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which approach best reflects motivational interviewing when a patient is ambivalent about reducing cannabis use?

  1. Telling the patient they must quit immediately
  2. Avoiding any discussion of substance use
  3. Confronting the patient about the harm of continued use
  4. Exploring the patient's own reasons for and against change Correct answer.

Explanation

Motivational interviewing is collaborative and elicits the patient's own reasons for change while respecting autonomy. Confrontation and directive demands tend to increase resistance.

Question 21Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A patient presents with agitation and severe hypertension after using a stimulant. Which complication should be considered when there is severe headache and altered mental status?

  1. Hypoglycemia
  2. Serotonin syndrome
  3. Opioid withdrawal
  4. Intracranial hemorrhage Correct answer.

Explanation

Stimulant-induced severe hypertension can cause intracranial hemorrhage, which should be considered with severe headache and altered mental status. Prompt neuroimaging is indicated in that setting.

Question 22Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which statement about the use of opioid agonist therapy during pregnancy is correct?

  1. Agonist therapy should be discontinued abruptly at conception
  2. Methadone or buprenorphine maintenance is recommended for opioid use disorder in pregnancy Correct answer.
  3. Detoxification alone is preferred over maintenance
  4. Naltrexone is first-line in pregnancy

Explanation

Methadone or buprenorphine maintenance is the standard of care for opioid use disorder in pregnancy, reducing relapse and improving maternal and fetal outcomes. Abrupt discontinuation risks withdrawal and relapse.

Question 23Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A patient in early recovery from alcohol use disorder reports insomnia and irritability. Which principle best guides management?

  1. These are common in early recovery and should be assessed and managed supportively Correct answer.
  2. They indicate the patient has relapsed
  3. They should be ignored as unrelated to recovery
  4. They require immediate long-term benzodiazepine prescribing

Explanation

Protracted withdrawal symptoms such as insomnia and irritability are common in early recovery and warrant assessment and supportive management. Long-term benzodiazepines risk cross-dependence and are generally avoided.

Question 24Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which screening approach is recommended for substance use in adolescents in primary care?

  1. Routine confidential screening with a validated tool Correct answer.
  2. No screening because of confidentiality concerns
  3. Screening only after a legal problem occurs
  4. Screening only when parents request it

Explanation

Confidential, routine screening with a validated adolescent tool is recommended to identify substance use early. Confidentiality protections support honest disclosure while balancing safety.

Question 25Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which laboratory finding is most consistent with chronic heavy alcohol use?

  1. Elevated gamma-glutamyl transferase and macrocytosis Correct answer.
  2. Low alkaline phosphatase
  3. Elevated troponin
  4. Isolated low ferritin

Explanation

Chronic heavy alcohol use commonly raises GGT and mean corpuscular volume, often alongside AST-predominant transaminase elevation. These markers support but do not by themselves diagnose alcohol use disorder.

Question 26Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 28-year-old man presents to the emergency department with dilated pupils, sweating, piloerection, yawning, and diarrhea that began 12 hours after his last heroin use. Which diagnosis is most likely?

  1. Alcohol withdrawal
  2. Opioid withdrawal Correct answer.
  3. Stimulant intoxication
  4. Opioid intoxication

Explanation

Opioid withdrawal classically presents with autonomic hyperactivity (mydriasis, diaphoresis, piloerection, yawning, diarrhea, rhinorrhea) beginning hours after last use. Intoxication causes miosis and respiratory depression, while alcohol withdrawal causes tremor and seizures but not mydriasis.

Question 27Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which medication is FDA-approved for the treatment of opioid use disorder and is available as a sublingual/buccal film combining buprenorphine with naloxone?

  1. Clonidine
  2. Buprenorphine/naloxone Correct answer.
  3. Methadone
  4. Naltrexone

Explanation

Buprenorphine/naloxone is a sublingual or buccal film approved for opioid use disorder; the naloxone is included to deter intravenous misuse. Methadone is approved but is not a combination product, and naltrexone is an antagonist available orally or as depot injection.

Question 28Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 45-year-old woman with severe alcohol use disorder is admitted with confusion, ataxia, and ophthalmoplegia. Which treatment should be given immediately?

  1. Oral disulfiram
  2. Intravenous lorazepam
  3. Oral naltrexone
  4. Intravenous thiamine Correct answer.

Explanation

The triad of confusion, ataxia, and ophthalmoplegia indicates Wernicke encephalopathy, a medical emergency treated with parenteral thiamine. Benzodiazepines treat alcohol withdrawal but not this thiamine-deficiency syndrome.

Question 29Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which screening tool is specifically designed to assess alcohol use in older adults?

  1. MAST-G Correct answer.
  2. DAST-10
  3. CAGE
  4. AUDIT-C

Explanation

The MAST-G (Michigan Alcoholism Screening Test–Geriatric version) is validated for older adults and includes items relevant to late-life drinking. The CAGE and AUDIT-C are general screens, and DAST-10 screens for drug use.

Question 30Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 32-year-old man with opioid use disorder is started on buprenorphine. He reports nausea and vomiting after the first dose. Which property of buprenorphine most likely explains this?

  1. Full mu-opioid agonism
  2. Kappa-opioid antagonism
  3. N-methyl-D-aspartate antagonism
  4. Partial mu-opioid agonism Correct answer.

Explanation

Buprenorphine is a partial mu-opioid agonist; at typical doses it can produce typical opioid side effects such as nausea, though with a ceiling effect on respiratory depression. Its kappa antagonism and NMDA activity do not primarily cause nausea.

Question 31Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 24-year-old college student is brought in after a night of heavy drinking. He is confused, has a heart rate of 120, blood pressure 150/90, and is tremulous. He reports his last drink was 8 hours ago. Which is the most appropriate initial pharmacologic treatment?

  1. Haloperidol
  2. Lorazepam Correct answer.
  3. Naltrexone
  4. Thiamine

Explanation

This presentation is consistent with alcohol withdrawal; benzodiazepines such as lorazepam are first-line to prevent progression to seizures and delirium. Antipsychotics alone may lower seizure threshold, and naltrexone is not used acutely.

Question 32Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which statement best describes the recommended approach to screening for unhealthy alcohol use in primary care?

  1. Screen only pregnant women.
  2. Screen all adults annually with a validated tool such as AUDIT-C. Correct answer.
  3. Screen only patients who request help with drinking.
  4. Screen only patients with abnormal liver enzymes.

Explanation

The USPSTF recommends screening all adults for unhealthy alcohol use with a validated instrument and providing brief counseling when indicated. Relying on patient request or lab abnormalities misses many affected individuals.

Question 33Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 40-year-old woman with alcohol use disorder has been abstinent for 3 months. She reports persistent low mood, anhedonia, and insomnia that began before she stopped drinking. Which diagnosis is most appropriate?

  1. Major depressive disorder Correct answer.
  2. Alcohol-induced depressive disorder
  3. Adjustment disorder
  4. Alcohol withdrawal

Explanation

Depressive symptoms that predate abstinence and persist beyond the expected withdrawal period suggest a primary major depressive disorder rather than a substance-induced mood disorder. Substance-induced depression typically emerges during intoxication or withdrawal and resolves with abstinence.

Question 34Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which medication is FDA-approved for both alcohol use disorder and opioid use disorder?

  1. Acamprosate
  2. Disulfiram
  3. Naltrexone Correct answer.
  4. Topiramate

Explanation

Naltrexone is approved for alcohol use disorder and opioid use disorder; it blocks opioid receptors and reduces alcohol reward. Acamprosate and disulfiram are only for alcohol use disorder, and topiramate is off-label.

Question 35Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 19-year-old man is brought to the ED with agitation, hyperthermia (40°C), muscle rigidity, and altered mental status after using MDMA at a rave. Which condition is most likely?

  1. Anticholinergic toxicity
  2. Serotonin syndrome Correct answer.
  3. Neuroleptic malignant syndrome
  4. Alcohol intoxication

Explanation

MDMA increases serotonin release and can cause serotonin syndrome, characterized by hyperthermia, rigidity, clonus, and altered mental status. Neuroleptic malignant syndrome is associated with dopamine antagonists and typically has bradyreflexia rather than clonus.

Question 36Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which intervention is most appropriate for a patient with opioid use disorder who is transitioning from methadone to buprenorphine?

  1. Start buprenorphine at a high dose to avoid withdrawal.
  2. Use naltrexone instead of buprenorphine.
  3. Start buprenorphine immediately after the last methadone dose.
  4. Wait until mild-to-moderate withdrawal signs appear before starting buprenorphine. Correct answer.

Explanation

Because buprenorphine is a partial agonist with high affinity, starting it while full agonist effects are present can precipitate withdrawal. Patients should be in mild-to-moderate withdrawal before induction.

Question 37Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 35-year-old man with cocaine use disorder has a positive urine drug screen for cocaine. He denies use. Which statement about urine drug testing is most accurate?

  1. Cocaine metabolites can be detected for 2-4 days after use. Correct answer.
  2. Confirmatory testing is never needed.
  3. A positive screen always indicates recent use within 24 hours.
  4. Urine testing cannot distinguish cocaine from amphetamines.

Explanation

Cocaine's metabolite benzoylecgonine is detectable in urine for roughly 2-4 days after use, so a positive result does not necessarily mean use within 24 hours. Immunoassays can cross-react, so confirmatory testing (e.g., GC-MS) is recommended for disputed results.

Question 38Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which behavioral therapy for substance use disorders is based on the principle that substance use is a learned behavior maintained by its consequences and aims to increase non-drug reinforcers?

  1. Motivational interviewing
  2. Contingency management Correct answer.
  3. Twelve-step facilitation
  4. Cognitive behavioral therapy

Explanation

Contingency management provides tangible rewards for verified abstinence or treatment attendance, based on operant conditioning. CBT targets maladaptive thoughts, MI addresses ambivalence, and 12-step facilitation promotes mutual support.

Question 39Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 50-year-old man with alcohol use disorder is admitted with pancreatitis. He develops tremor, diaphoresis, and a seizure 24 hours after admission. Which is the most appropriate next step?

  1. Administer an antipsychotic such as haloperidol.
  2. Administer a benzodiazepine such as diazepam. Correct answer.
  3. Start disulfiram.
  4. Start acamprosate.

Explanation

Seizure during alcohol withdrawal is treated with benzodiazepines, which are first-line for withdrawal and its complications. Antipsychotics do not prevent seizures, and acamprosate and disulfiram are maintenance medications.

Question 40Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which statement about nicotine metabolism and smoking cessation is correct?

  1. Nicotine is primarily metabolized by CYP3A4.
  2. CYP2A6 slow metabolizers may respond better to nicotine replacement therapy. Correct answer.
  3. Bupropion is a nicotinic partial agonist.
  4. Varenicline is a nicotine receptor antagonist.

Explanation

Nicotine is metabolized mainly by CYP2A6; slow metabolizers have higher nicotine levels and may have better response to nicotine replacement. Varenicline is a partial agonist, and bupropion inhibits dopamine and norepinephrine reuptake.

Question 41Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 60-year-old woman with alcohol use disorder and cirrhosis is admitted with confusion. She has asterixis and elevated ammonia. Which medication is most appropriate for her chronic management?

  1. Lactulose Correct answer.
  2. Naltrexone
  3. Acamprosate
  4. Disulfiram

Explanation

Hepatic encephalopathy is managed with lactulose to reduce ammonia absorption. Naltrexone and disulfiram are hepatotoxic and generally avoided in severe liver disease; acamprosate is not used for encephalopathy.

Question 42Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which medication is used for alcohol use disorder and requires monitoring of renal function because it is renally excreted?

  1. Naltrexone
  2. Disulfiram
  3. Acamprosate Correct answer.
  4. Topiramate

Explanation

Acamprosate is eliminated renally and requires dose adjustment in renal impairment. Disulfiram and naltrexone are hepatically metabolized, and topiramate is primarily renally excreted but not FDA-approved for alcohol use disorder.

Question 43Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 26-year-old woman with opioid use disorder is 20 weeks pregnant. She is currently on methadone maintenance. Which statement is most accurate regarding her care?

  1. Methadone should be discontinued to avoid neonatal abstinence syndrome.
  2. Methadone maintenance should be continued with appropriate dose adjustment. Correct answer.
  3. Detoxification is recommended in the third trimester.
  4. Buprenorphine is contraindicated in pregnancy.

Explanation

Opioid agonist therapy with methadone or buprenorphine is recommended in pregnancy and should be continued; abrupt discontinuation risks relapse and poor outcomes. Neonatal abstinence syndrome is managed after delivery.

Question 44Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which finding on physical examination is most suggestive of chronic heavy alcohol use?

  1. Pupillary constriction
  2. Bilateral parotid enlargement Correct answer.
  3. Needle track marks
  4. Nasal septal perforation

Explanation

Bilateral parotid enlargement is a classic sign of chronic alcohol use. Pupillary constriction suggests opioid use, needle marks suggest injection drug use, and septal perforation suggests cocaine insufflation.

Question 45Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 30-year-old man with cannabis use disorder wants to quit but is ambivalent. Which response best reflects motivational interviewing?

  1. "Let me tell you about the risks of cannabis."
  2. "You've noticed some downsides to using, and you're not sure you want to stop right now." Correct answer.
  3. "You should stop using cannabis immediately; it's harming your health."
  4. "If you don't stop, you'll end up in the hospital."

Explanation

Motivational interviewing uses reflective listening to explore ambivalence without confrontation. The other responses are confrontational or advice-giving, which can increase resistance.

Question 46Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which statement about the use of disulfiram is correct?

  1. It is safe to use in patients with severe myocardial disease.
  2. It requires informed consent and should not be given without the patient's knowledge. Correct answer.
  3. It reduces alcohol craving.
  4. It is first-line for most patients with alcohol use disorder.

Explanation

Disulfiram produces an aversive reaction to alcohol and must be used with informed consent; covert administration is unethical and dangerous. It is not first-line, does not reduce craving, and is contraindicated in severe cardiac disease.

Question 47Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 22-year-old man is brought in with agitation, tachycardia, and hypertension after using an unknown substance. He has a temperature of 39°C and dilated pupils. Which complication should be considered?

  1. Hypoglycemia
  2. Serotonin syndrome
  3. Opioid overdose
  4. Intracranial hemorrhage Correct answer.

Explanation

Stimulant use (e.g., cocaine, methamphetamine) can cause severe hypertension and agitation, increasing the risk of intracranial hemorrhage. Opioid overdose causes miosis and respiratory depression, and hypoglycemia does not typically cause hypertension.

Question 48Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

Which statement about neonatal opioid withdrawal syndrome (NOWS) is accurate?

  1. It is always severe and requires pharmacologic treatment.
  2. Nonpharmacologic measures such as rooming-in and breastfeeding can reduce the need for medication. Correct answer.
  3. It typically presents within the first hour of life.
  4. It occurs only with maternal methadone use, not buprenorphine.

Explanation

Nonpharmacologic care (rooming-in, breastfeeding, swaddling) is first-line and can reduce medication need. NOWS severity varies, occurs with both methadone and buprenorphine, and usually presents within 24-72 hours.

Question 49Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 45-year-old man with alcohol use disorder has been abstinent for 6 months. He reports persistent insomnia and irritability. Which principle best guides management?

  1. Symptoms always indicate relapse and require immediate detoxification.
  2. Benzodiazepines are the preferred long-term treatment for insomnia in recovery.
  3. Insomnia in early recovery is unrelated to alcohol use.
  4. Protracted withdrawal symptoms can persist for months and should be managed supportively. Correct answer.

Explanation

Protracted withdrawal symptoms such as insomnia and irritability can last for months after cessation and are managed with supportive care and nonpharmacologic strategies. Benzodiazepines should be avoided long-term due to dependence risk.

Question 50Prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction

A 38-year-old woman with opioid use disorder is considering naltrexone. Which prerequisite is most important before starting naltrexone?

  1. A baseline ECG showing QTc less than 500 ms.
  2. Documented abstinence from alcohol for 1 month.
  3. Complete opioid withdrawal for 7-10 days. Correct answer.
  4. Liver function tests within normal limits.

Explanation

Naltrexone is an opioid antagonist and can precipitate severe withdrawal if opioids are still present; patients should be opioid-free for 7-10 days. ECG monitoring is more relevant to methadone, and LFTs are a consideration but not the key prerequisite.