Addiction Medicine Certification Examination (ABPM) — Questions and Answers

Question 1: A patient on buprenorphine/naloxone for opioid use disorder is diagnosed with ADHD. Which stimulant strategy is most appropriate?

Amphetamines should be started immediately at high doses
Stimulants can be started without any additional monitoring
Stimulants are absolutely contraindicated in all patients on MOUD
Non-stimulant medications like atomoxetine should be considered first (Correct answer)

Correct answer: Non-stimulant medications like atomoxetine should be considered first

Non-stimulant medications like atomoxetine are generally preferred first in patients with substance use disorder and ADHD to minimize misuse risk, though stimulants may be considered with close monitoring.

Question 2: A patient who has been sober for 18 months begins withdrawing from friends, skipping meetings, and rationalizing occasional drinking. This pattern is best described as:

Behavioral relapse
Physical relapse
Emotional relapse (Correct answer)
Mental relapse

Correct answer: Emotional relapse

Emotional relapse involves behavioral and emotional warning signs (isolation, poor self-care) that precede any conscious thoughts about using substances.

Question 3: Which medication used in alcohol use disorder works by sensitizing patients to acetaldehyde, causing an aversive reaction when alcohol is consumed?

Naltrexone
Gabapentin
Acamprosate
Disulfiram (Correct answer)

Correct answer: Disulfiram

Disulfiram inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde when alcohol is consumed, resulting in flushing, nausea, vomiting, and palpitations.

Question 4: When developing a treatment plan for a patient with stimulant use disorder, which pharmacological approach has the strongest evidence base?

No FDA-approved medications; behavioral therapies are primary (Correct answer)
Naltrexone extended-release injection
Bupropion monotherapy
Modafinil combined with contingency management

Correct answer: No FDA-approved medications; behavioral therapies are primary

There are currently no FDA-approved medications for stimulant use disorder, making behavioral interventions such as contingency management the first-line treatment approach.

Question 5: What is informed consent in Addiction Medicine Certification professional practice?

Providing complete information about services, risks, and alternatives for voluntary decisions (Correct answer)
Having clients sign without explanation
Verbal agreement only
Third-party consent

Correct answer: Providing complete information about services, risks, and alternatives for voluntary decisions

Informed consent requires clear, complete information about proposed services, risks, outcomes, and alternatives so clients can make knowledgeable decisions.

Question 6: What should a Addiction Medicine Certification professional do upon discovering a colleague's unethical conduct?

Ignore it to maintain harmony
Report through appropriate channels with proper documentation (Correct answer)
Confront publicly at a meeting
Post anonymously online

Correct answer: Report through appropriate channels with proper documentation

Professionals have an obligation to report misconduct through proper channels while documenting observations to support investigation.

Question 7: What is a risk matrix used for in Addiction Medicine Certification practice?

Mapping facility layouts
Evaluating risks by plotting likelihood against impact severity (Correct answer)
Creating task schedules
Tracking attendance

Correct answer: Evaluating risks by plotting likelihood against impact severity

A risk matrix plots probability against consequences to prioritize which risks need immediate attention.

Question 8: What is the hierarchy of controls in Addiction Medicine Certification risk management?

Elimination, substitution, engineering, administrative, then PPE (Correct answer)
Insurance, training, documentation
PPE first, then administrative
Assessment, planning, implementation

Correct answer: Elimination, substitution, engineering, administrative, then PPE

The hierarchy prioritizes the most effective controls first, from eliminating the hazard to using PPE as last resort.

Question 9: What is the first step in Addiction Medicine Certification risk assessment?

Identifying potential hazards and threats (Correct answer)
Ignoring minor risks
Purchasing insurance
Assigning blame

Correct answer: Identifying potential hazards and threats

Risk assessment begins with systematic identification of all potential hazards, forming the foundation for all subsequent analysis.

Question 10: What is peer review in Addiction Medicine Certification Pharmacology & Medication Management?

Reducing workloads
Determining promotions
Creating competition
Quality evaluation by qualified colleagues for improvement (Correct answer)

Correct answer: Quality evaluation by qualified colleagues for improvement

Peer review provides objective assessment by qualified professionals to identify improvements and ensure accountability.

Question 11: What is a Addiction Medicine Certification professional's obligation regarding confidentiality?

Protecting client information and disclosing only with authorization or legal requirement (Correct answer)
Discussing cases with family
Sharing freely with other professionals
Using as marketing material

Correct answer: Protecting client information and disclosing only with authorization or legal requirement

Confidentiality requires protecting all client information from unauthorized disclosure, sharing only with consent or legal mandate.

Question 12: The Community Reinforcement Approach (CRA) primarily focuses on which strategy to support abstinence?

Educating family members about enabling behaviors
Emphasizing the negative consequences of drug use
Prescribing medications to reduce cravings
Restructuring the patient's social environment to make abstinence more rewarding than use (Correct answer)

Correct answer: Restructuring the patient's social environment to make abstinence more rewarding than use

CRA restructures the patient's environment and lifestyle so that natural rewards from relationships, work, and recreation become more reinforcing than substance use.

Question 13: Mindfulness-Based Relapse Prevention (MBRP) teaches patients to respond to cravings using which core strategy?

Replacing cravings with physical exercise
Urge surfing — observing cravings without acting on them (Correct answer)
Immediately calling a sponsor
Distraction through engaging media

Correct answer: Urge surfing — observing cravings without acting on them

MBRP uses 'urge surfing,' a mindfulness technique where patients observe craving sensations like waves that rise and fall without reacting to or acting on them.

Question 14: A patient with opioid use disorder who is stable on buprenorphine/naloxone undergoes an elective cholecystectomy. Which perioperative opioid management strategy is most consistent with current evidence?

Discontinue buprenorphine 72 hours before surgery and use full agonist opioids
Convert to oral morphine equivalents based on buprenorphine dose
Switch to methadone 2 weeks before surgery for better opioid flexibility
Continue buprenorphine through the perioperative period and use multimodal analgesia (Correct answer)

Correct answer: Continue buprenorphine through the perioperative period and use multimodal analgesia

Current evidence and guidelines support continuing buprenorphine perioperatively and supplementing with multimodal non-opioid analgesia, as discontinuation increases relapse risk without clear analgesic benefit.

Question 15: Which medication for smoking cessation is associated with a black box warning (now removed by FDA in 2016 but still clinically monitored) related to neuropsychiatric adverse events?

Nicotine replacement therapy (patch)
Nortriptyline
Varenicline (Chantix) (Correct answer)
Bupropion SR

Correct answer: Varenicline (Chantix)

Varenicline carried an FDA black box warning for serious neuropsychiatric events (depression, suicidality, behavioral changes) that was removed in 2016 after the EAGLES trial showed no significant excess risk.

Question 16: In the MATRICS framework for opioid use disorder pharmacotherapy, which of the following is NOT an FDA-approved medication for OUD?

Buprenorphine
Naltrexone
Methadone
Clonidine (Correct answer)

Correct answer: Clonidine

Clonidine is not FDA-approved for OUD treatment; it is used off-label to manage opioid withdrawal symptoms such as anxiety, agitation, and autonomic hyperactivity.

Question 17: How does professional liability insurance protect Addiction Medicine Certification practitioners?

Covering disaster damage
Covering financial losses from claims of negligence or errors (Correct answer)
Protecting against equipment theft
Paying health premiums

Correct answer: Covering financial losses from claims of negligence or errors

This insurance covers financial consequences of claims alleging negligence or mistakes in professional services.

Question 18: What is the primary purpose of screening in addiction medicine?

Monitor medication adherence
Identify individuals at risk for substance use disorders (Correct answer)
Diagnose psychiatric conditions
Recommend detox centers

Correct answer: Identify individuals at risk for substance use disorders

The primary purpose of screening in addiction medicine is to quickly identify individuals who may be at risk for or already experiencing substance use disorders. This initial step helps healthcare providers determine if a more comprehensive assessment is warranted, enabling early intervention and appropriate referral to treatment services.

Question 19: Understanding the neurobiology of addiction has most directly informed which clinical approach?

Criminal justice deterrents using punishment to reduce substance use
Confrontational counseling techniques aimed at breaking denial
Medication-assisted treatment targeting specific neurobiological receptor systems disrupted by addiction (Correct answer)
Abstinence-only treatment programs that discourage all medications

Correct answer: Medication-assisted treatment targeting specific neurobiological receptor systems disrupted by addiction

Understanding specific neurobiological mechanisms has directly enabled development of targeted pharmacotherapies such as methadone, buprenorphine, and naltrexone that act on the same receptor systems affected by addictive substances.

Question 20: Which medication helps reduce alcohol cravings?

Modafinil
Lorazepam
Acamprosate (Correct answer)
Naloxone

Correct answer: Acamprosate

Acamprosate is a medication specifically used to help individuals maintain abstinence from alcohol by reducing cravings and withdrawal symptoms. It is believed to work by restoring the balance of neurotransmitters in the brain that are disrupted by chronic alcohol use, thereby decreasing the desire to drink and supporting long-term sobriety.

Question 21: Which AUDIT-C score threshold is commonly used to indicate hazardous drinking in men?

3 or more
8 or more
4 or more (Correct answer)
6 or more

Correct answer: 4 or more

An AUDIT-C score of 4 or more in men (3 or more in women) indicates hazardous or harmful alcohol use.

Question 22: Which benzodiazepine is preferred for alcohol withdrawal management in patients with severe hepatic impairment due to its lack of active metabolites?

Lorazepam (Correct answer)
Diazepam
Chlordiazepoxide
Clonazepam

Correct answer: Lorazepam

Lorazepam (along with oxazepam and temazepam) undergoes direct glucuronidation without forming active metabolites, making it safer in hepatic impairment.

Question 23: When conducting a biopsychosocial assessment for substance use disorder, which domain specifically examines family history of addiction?

Biological domain (Correct answer)
Spiritual domain
Social domain
Psychological domain

Correct answer: Biological domain

The biological domain of a biopsychosocial assessment includes genetic predisposition and family history of substance use disorders.

Question 24: Why is it important to assess co-occurring mental health conditions?

To increase medication dosage
To tailor treatment to the patient’s full needs (Correct answer)
To justify treatment duration
To meet insurance requirements

Correct answer: To tailor treatment to the patient’s full needs

Assessing co-occurring mental health conditions is crucial because these conditions significantly impact the presentation, course, and treatment outcomes of substance use disorders. By addressing both mental health and substance use simultaneously, clinicians can tailor an integrated treatment plan that meets the patient's full needs, leading to more effective and sustainable recovery.

Question 25: In a patient with schizophrenia and cannabis use disorder, which antipsychotic has the most evidence for reducing cannabis use?

Chlorpromazine
Perphenazine
Haloperidol
Clozapine (Correct answer)

Correct answer: Clozapine

Clozapine has the strongest evidence among antipsychotics for reducing substance use, including cannabis, in patients with schizophrenia.

Question 26: Which integrated treatment model delivers mental health and substance use services within the same program and clinical team?

Sequential treatment model
Stepped care model
Parallel treatment model
Integrated dual disorder treatment (IDDT) (Correct answer)

Correct answer: Integrated dual disorder treatment (IDDT)

Integrated Dual Disorder Treatment (IDDT) is the evidence-based model where mental health and substance use services are provided by the same team in the same setting.

Question 27: What is the primary purpose of a code of ethics in Addiction Medicine Certification practice?

To determine salary structures
To establish professional conduct standards and guide ethical decision-making (Correct answer)
To set pricing for professional services
To define standard office hours

Correct answer: To establish professional conduct standards and guide ethical decision-making

A code of ethics provides a framework of professional values and behavioral standards that guides practitioners in ethical decisions while maintaining public trust.

Question 28: Which neurobiological change is particularly severe and long-lasting in methamphetamine addiction?

Dopaminergic neurotoxicity with loss of striatal dopamine terminals (Correct answer)
Irreversible loss of serotonin synthesis capacity
Decreased GABA receptor density in the cortex
Permanent mu-opioid receptor upregulation

Correct answer: Dopaminergic neurotoxicity with loss of striatal dopamine terminals

Methamphetamine causes significant dopaminergic neurotoxicity through oxidative stress and excitotoxicity, leading to loss of dopamine nerve terminals in the striatum that can persist for years.

Question 29: Patients taking methadone should be monitored for which electrolyte abnormality that can worsen QTc prolongation?

Hypomagnesemia and hypokalemia (Correct answer)
Hypercalcemia
Hyperkalemia
Hypernatremia

Correct answer: Hypomagnesemia and hypokalemia

Hypomagnesemia and hypokalemia both prolong cardiac repolarization and can potentiate methadone-induced QTc prolongation, increasing the risk of torsades de pointes.

Question 30: What is the recommended clinical monitoring parameter for patients on disulfiram therapy for alcohol use disorder?

QTc interval via serial ECGs
Renal function tests due to drug accumulation
Liver function tests due to risk of hepatotoxicity (Correct answer)
Complete blood count for agranulocytosis risk

Correct answer: Liver function tests due to risk of hepatotoxicity

Disulfiram can cause hepatotoxicity; baseline and periodic liver function tests are recommended, and it is contraindicated in patients with severe hepatic impairment.

Addiction Medicine Certification Examination (ABPM)

The ABPM Addiction Medicine Certification Examination tests physicians' competency across the full spectrum of addiction medicine, including neurobiology, pharmacology, clinical management of substance use disorders, prevention, and ethics. It is delivered in four one-hour blocks totaling 200 questions.

200

Questions

240 min

Time Limit

70%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

theabpm.org — Fees, late registration, registration, test dates, eligibility, retake policy, score release, exam format · verified Oct 2026
pearsonvue.com — Test delivery · verified Oct 2026