Addiction Medicine Screening & Evaluation Flashcards

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

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.

The DAST-10 is a validated screening tool used to detect problems related to which substance category?

Answer: Drug use (non-alcohol)

The Drug Abuse Screening Test (DAST-10) is specifically designed to screen for problems related to non-alcohol drug use.

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

Answer: Biological domain

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

A patient scores 15 on the CIWA-Ar scale. Which clinical management is most appropriate?

Answer: Inpatient medical detoxification

A CIWA-Ar score of 15 indicates moderate-to-severe alcohol withdrawal, requiring inpatient medical detoxification for safe management.

Which screening tool uses a single question — 'How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?' — as its core item?

Answer: Single-Item Drug Screen

The Single-Item Drug Screening Question (SISQ) is a validated one-question tool shown to be effective in primary care settings.

In the FRAMES model used during brief interventions, what does the letter 'R' stand for?

Answer: Responsibility

In FRAMES, 'R' stands for Responsibility, emphasizing that the patient is responsible for their own behavior change.

Which laboratory finding is most suggestive of chronic heavy alcohol use when liver enzymes are elevated?

Answer: AST/ALT ratio greater than 2:1

An AST-to-ALT ratio greater than 2:1 is a classic marker of alcoholic liver disease, distinguishing it from other hepatic causes.

Which component of the ASAM Criteria assesses a patient's readiness and interest in changing their substance use behavior?

Answer: Dimension 4: Readiness to Change

ASAM Dimension 4 specifically addresses the patient's readiness to change and stage of motivation, guiding treatment engagement strategies.

A urine drug screen is positive for benzodiazepines, but the patient reports no prescription. Which next step is most appropriate?

Answer: Order a confirmatory GC-MS test

Immunoassay screens have cross-reactivity and can produce false positives; GC-MS (gas chromatography–mass spectrometry) is the gold-standard confirmatory test.

Which finding on a urine drug screen would most indicate possible sample adulteration?

Answer: Creatinine below 2 mg/dL with normal color

A creatinine below 2 mg/dL is physiologically impossible in real urine and, combined with abnormal specific gravity, indicates specimen substitution or adulteration.

A patient with opioid use disorder is being evaluated for buprenorphine initiation. Which COWS score range best indicates readiness to begin induction?

Answer: 13–24 (moderate withdrawal)

A COWS score of 13–24 (moderate withdrawal) is generally the target range to begin buprenorphine induction, reducing precipitated withdrawal risk.

Which of the following best describes the purpose of the 'Stages of Change' model in addiction screening?

Answer: To identify the patient's current readiness to change behavior

The Transtheoretical Model's Stages of Change (precontemplation through maintenance) identifies where a patient is in their motivation to change, informing intervention style.

When screening a pregnant patient for substance use, which approach is recommended by ACOG and SAMHSA?

Answer: Universal screening using a validated questionnaire at the first prenatal visit

ACOG and SAMHSA recommend universal verbal screening with a validated questionnaire at the first prenatal visit, using a non-punitive, supportive approach.

Which DSM-5 feature distinguishes a substance use disorder from substance dependence as defined in DSM-IV?

Answer: DSM-5 eliminated 'substance abuse' and 'dependence' as separate categories

DSM-5 unified the former 'abuse' and 'dependence' categories into a single Substance Use Disorder spectrum, eliminating the abuse/dependence distinction.

A 45-year-old patient presents with pinpoint pupils, decreased respirations, and altered mental status. Which screening tool is most appropriate to assess opioid withdrawal risk AFTER stabilization?

Answer: COWS

The Clinical Opiate Withdrawal Scale (COWS) is the validated tool to assess opioid withdrawal severity and guide treatment decisions post-stabilization.

During a structured interview, a patient endorses using alcohol to 'relieve stress.' This most likely represents which concept in addiction evaluation?

Answer: Negative reinforcement

Using a substance to relieve negative states (stress, anxiety) is a textbook example of negative reinforcement, a key driver of substance use maintenance.

Which of the following is considered the gold-standard screening approach recommended by NIDA for use in primary care settings?

Answer: NIDA Quick Screen followed by NIDA-Modified ASSIST

NIDA recommends its Quick Screen as the first step, followed by the NIDA-Modified ASSIST for a more detailed evaluation when initial screening is positive.

A patient's hair follicle drug test is positive for cocaine. Approximately how far back in time does this result reflect use?

Answer: Up to 90 days

Hair follicle testing can detect drug use for approximately 90 days (3 months), based on the rate of hair growth of about 1 cm per month.

Which factor is most important when selecting a screening tool for a patient with low health literacy?

Answer: Reading level and question simplicity

For patients with low health literacy, choosing a tool with simple language and low reading-level demands is essential for accurate self-report.

Which of the following best describes the purpose of ASAM Dimension 6 in the patient evaluation process?

Answer: Evaluating the patient's living environment and social supports

ASAM Dimension 6 (Recovery/Living Environment) evaluates the patient's home, social network, and community supports that will affect recovery outcomes.