Mixed Deck — All Addiction Medicine Certification Topics Flashcards

A patient on methadone maintenance presents with a QTc of 520 ms on ECG. What is the most appropriate next step?

Answer: Immediately switch to buprenorphine and consult cardiology

A QTc >500 ms on methadone carries significant risk of torsades de pointes; transitioning to buprenorphine (which has minimal QT effect) with cardiology consultation is indicated.

Why does abrupt alcohol withdrawal cause seizures?

Answer: Rebound NMDA receptor hyperactivity and reduced GABA function due to neuroadaptation

Chronic alcohol use upregulates NMDA receptors and downregulates GABA-A receptors; abrupt cessation leaves the brain in a hyperexcitable state due to these neuroadaptations, leading to seizure risk.

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.

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.

In CBT for substance use disorders, a 'high-risk situation' is defined as:

Answer: A situation, emotion, or cue that increases the likelihood of substance use

In CBT, a high-risk situation is any internal or external trigger — emotional, interpersonal, or environmental — that elevates the probability that the patient will use substances.

When initiating buprenorphine in the office setting, a patient should ideally be in mild-to-moderate opioid withdrawal (COWS score ≥8-12) to avoid which complication?

Answer: Precipitated withdrawal

Buprenorphine's high mu-receptor affinity displaces full agonists; if given while opioids still occupy receptors, it precipitates acute withdrawal.

Which core process in Acceptance and Commitment Therapy (ACT) for addiction encourages patients to observe thoughts without fusion or avoidance?

Answer: Cognitive defusion

Cognitive defusion in ACT teaches patients to observe their cravings and urge-related thoughts as transient mental events rather than truths that must be acted upon.

What is the critical path in Addiction Medicine Certification project scheduling?

Answer: The longest sequence of dependent tasks determining minimum duration

The critical path identifies the longest chain of dependent tasks; delays on these directly delay project completion.

Which biomarker has the longest detection window for chronic heavy alcohol consumption?

Answer: Phosphatidylethanol (PEth)

Phosphatidylethanol (PEth) can detect heavy alcohol use for up to 3–4 weeks, giving it the longest detection window among common biomarkers.

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.

What is the mechanism by which nicotine replacement therapy (NRT) aids smoking cessation?

Answer: It provides low-level nicotine to reduce withdrawal symptoms while behavioral conditioning is broken

NRT delivers controlled, lower levels of nicotine to reduce withdrawal symptoms and cravings, allowing the behavioral and psychological aspects of smoking to be addressed without the harmful combustion products.

A patient with opioid use disorder on buprenorphine maintenance reports a relapse after losing their job. Which intervention is MOST appropriate at this point?

Answer: Continue buprenorphine and address psychosocial stressors

Relapse during MOUD does not indicate treatment failure; continuing medication while addressing the underlying psychosocial trigger is the evidence-based response.

Which medication used off-label for alcohol use disorder has evidence for reducing heavy drinking days and works by blocking sodium channels and enhancing GABA activity?

Answer: Topiramate

Topiramate reduces heavy drinking days through multiple mechanisms including sodium channel blockade and GABA enhancement, though it is not FDA-approved for AUD.

In patients with co-occurring opioid use disorder and chronic pain, which buprenorphine formulation offers the advantage of providing both OUD treatment and chronic pain management?

Answer: Buprenorphine transdermal patch (Butrans) or buccal film (Belbuca) at analgesic doses

Low-dose buprenorphine transdermal (Butrans) and buccal (Belbuca) formulations are FDA-approved for chronic pain and may address both conditions, though OUD-level dosing typically requires sublingual forms.

Which component is essential during a comprehensive addiction evaluation?

Answer: Biopsychosocial assessment

A comprehensive addiction evaluation requires a biopsychosocial assessment to understand the multifaceted nature of addiction. This approach considers biological factors (e.g., genetics, physical health), psychological factors (e.g., mental health, coping skills), and social factors (e.g., environment, relationships) to create a holistic picture of the patient's needs and inform treatment.

A physician recommends 12-step facilitation therapy (TSF) for a patient with alcohol use disorder. TSF primarily works by:

Answer: Encouraging acceptance of powerlessness and participation in AA meetings

TSF is a structured approach that encourages patients to engage with 12-step programs by accepting powerlessness over alcohol and beginning AA participation.

The endocannabinoid system's primary role in addiction neurobiology involves:

Answer: Modulating synaptic plasticity and reward processing via CB1 and CB2 receptors

The endocannabinoid system, through CB1 and CB2 receptors, modulates synaptic plasticity and reward processing and plays a key role in the motivational aspects of multiple substance use disorders.

When differentiating substance-induced psychosis from primary psychosis, which timeframe is most commonly used for observation after abstinence?

Answer: 4 weeks

DSM-5 guidelines suggest that if psychotic symptoms persist beyond 4 weeks of abstinence, a primary psychotic disorder is more likely.

What is the mechanism of action of naltrexone in addiction treatment?

Answer: Opioid receptor blocker

Naltrexone is an opioid receptor blocker, meaning it binds to and blocks opioid receptors in the brain. By doing so, it prevents opioids from producing their euphoric effects, which helps reduce cravings and the reinforcing properties of opioid use, making it a valuable tool in preventing relapse for both opioid and alcohol use disorders.

What is an aftercare plan?

Answer: A plan for ongoing support after treatment

An aftercare plan is a critical component of addiction treatment, outlining strategies and resources for continued support and relapse prevention once formal treatment concludes. It typically includes recommendations for ongoing therapy, support groups, medication management, and lifestyle adjustments to maintain long-term sobriety and well-being.