ABPN Addiction Psychiatry study plan

Diagram the mesolimbic and mesocortical reward pathways from ventral tegmental area to nucleus accumbens and prefrontal cortex, labeling where dopamine, GABA, glutamate, and endogenous opioid signaling act.

Distinguish tolerance, physical dependence, withdrawal, and addiction by writing an operational definition and one clinical example for each.

Explain the three-stage addiction cycle (binge/intoxication, withdrawal/negative affect, preoccupation/anticipation) and identify which neuroadaptive change drives the shift from positive to negative reinforcement.

Contrast the acute molecular actions of alcohol (GABA-A potentiation, NMDA antagonism), opioids (mu-receptor agonism), and stimulants (dopamine transporter blockade and reverse transport).

Tabulate onset, half-life, lipophilicity, and route-dependent bioavailability for alcohol, heroin and prescription opioids, cocaine, methamphetamine, nicotine, cannabis, and benzodiazepines.

Compare the withdrawal syndromes of alcohol, opioids, benzodiazepines, and stimulants by time course, peak severity window, and risk of seizure, delirium, or death.

Explain kindling and its implications for repeated alcohol or sedative-hypnotic withdrawal, including why vital-sign monitoring and benzodiazepine tapering matter.

Summarize the heritability estimates and candidate gene or epigenetic findings for alcohol, opioid, and nicotine use disorders, and state how gene-environment interaction modifies risk.

Interpret a urine drug screen result against known detection windows and explain why immunoassay false positives and confirmatory testing matter.

Rank first-line pharmacotherapy for alcohol, opioid, and tobacco use disorders by strength of evidence and state the contraindications for each agent.

Write an induction sequence for buprenorphine that includes starting dose, pre-induction withdrawal requirement, and titration targets, and contrast it with methadone clinic-based dosing.

Calculate naltrexone's hepatotoxicity threshold, list baseline and follow-up liver monitoring, and identify patients in whom it should be avoided.

Differentiate disulfiram, acamprosate, topiramate, gabapentin, varenicline, bupropion, and nicotine replacement by mechanism, dosing, and adverse effect profile.

Apply current federal prescribing and confidentiality requirements to a case involving office-based buprenorphine and a request for records from a family member.

Compare motivational interviewing, cognitive behavioral therapy, contingency management, twelve-step facilitation, and family or couples therapy by target mechanism and evidence base, and match each to a clinical scenario.

Sequence levels of care using ASAM criteria for a patient with two prior relapses and unstable housing.

Draft a written relapse-prevention plan that names triggers, coping skills, a support network, and measurable follow-up intervals.

Explain how contingency management is implemented (reinforcer choice, frequency, schedule) and describe the regulatory and funding barriers that limit its use.

Administer and score AUDIT-C, CAGE, DAST-10, ASSIST, CIWA-Ar, and COWS from written item responses and interpret the resulting cut scores.

Apply all eleven DSM-5-TR criteria for substance use disorder to a narrative case and assign severity, course specifiers, and remission status.

Select and interpret laboratory markers of heavy drinking (GGT, CDT, PEth, ethyl glucuronide) by sensitivity and detection window, and explain when each is appropriate.

Differentiate substance-induced mood, anxiety, and psychotic syndromes from primary psychiatric disorders using temporal criteria and longitudinal course.

Adjust treatment for pregnancy by selecting methadone or buprenorphine over agonist-free detoxification and describing neonatal opioid withdrawal monitoring.

Modify assessment and treatment for adolescents, older adults, and patients with chronic pain on long-term opioids, applying age-specific screening tools and Beers-style cautions.

Construct an integrated plan for co-occurring PTSD, major depression, or psychotic illness that specifies sequencing of addiction and psychiatric treatment.

Identify system-level barriers including stigma, insurance authorization, transportation, housing instability, and criminal legal involvement, and name one mitigation for each.

Map the ASAM levels of care and describe which patient presentations are misallocated if the level is chosen by insurance rather than clinical need.

Apply 42 CFR Part 2 and HIPAA confidentiality rules to a written request for substance use records from an employer and from a treating psychiatrist.

Review all previously missed items across Domains 1 through 3 and rewrite the reasoning for each until the corrected explanation is accurate without notes.

Summarize harm reduction measures including naloxone distribution, fentanyl test strips, and syringe services, and state the evidence supporting each.

Sit two timed 100-question simulated blocks under exam conditions and review every item, right or wrong, for the reasoning behind the correct answer.

Recite from memory the dosing, titration, and key adverse effects of every medication on the addiction psychiatry formulary.

Condense high-yield numbers (detection windows, cut scores, half-lives, withdrawal timelines) onto a single rapid-recall sheet.

Verify exam-day logistics and rehearse a timing strategy for flagged questions.