Prevention, Evaluation, Diagnosis, Treatment, and Recovery of Addiction
The disease model and its clinical consequences
Addiction is a chronic, relapsing condition with genetic, neurobiologic, developmental, and environmental contributors. The candidate must be fluent in the DSM-5 substance use disorder (SUD) framework: a single disorder per substance, graded mild (2–3 criteria), moderate (4–5), or severe (6+), replacing the old abuse/dependence split. Know the criteria clusters - impaired control, social impairment, risky use, and pharmacologic criteria (tolerance, withdrawal) - and remember that tolerance and withdrawal alone do not establish severity in a patient taking a prescribed medication under medical supervision.
Evaluation and diagnosis
Screening (AUDIT-C, DAST, single-item questions) is not diagnosis. Diagnosis requires a clinical assessment: substance-by-substance history, pattern and route, consequences, prior treatment, psychiatric comorbidity, and a collateral source when possible. Use validated tools (CIWA-Ar for alcohol withdrawal severity, COWS for opioid withdrawal) as adjuncts, not substitutes for judgment. Laboratory markers (GGT, CDT, EtG) support but do not diagnose.
Treatment and recovery
Match treatment intensity to severity: brief intervention for risky use, structured outpatient for mild–moderate SUD, and medically managed intensive services for severe SUD or dangerous withdrawal. Medications are first-line where evidence exists - naltrexone and acamprosate for alcohol use disorder, buprenorphine and methadone for opioid use disorder, nicotine replacement/varenicline for tobacco. Recovery is broader than abstinence and includes sustained remission, function, and quality of life.
Traps
Questions often reward the least restrictive effective setting, medication for OUD as standard of care (not a substitute for counseling only), and recognition that relapse is part of a chronic illness course rather than treatment failure.
Rule of thumb: diagnose by criteria, treat by severity, and always pair medication with psychosocial support.