Addiction Medicine Certification Addiction Medicine Recovery & Relapse Prevention — Questions and Answers

Question 1: Which cognitive-behavioral therapy technique is specifically designed to help patients identify high-risk situations for relapse?

Functional analysis (Correct answer)
Systematic desensitization
Flooding
Aversion therapy

Correct answer: Functional analysis

Functional analysis identifies the antecedents, behaviors, and consequences that precede substance use, helping patients recognize high-risk situations.

Question 2: A patient in recovery reports experiencing anhedonia, fatigue, and strong cravings six weeks after stopping cocaine use. This presentation is most consistent with:

Post-acute withdrawal syndrome (PAWS) (Correct answer)
Major depressive disorder
Acute withdrawal
Adjustment disorder

Correct answer: Post-acute withdrawal syndrome (PAWS)

PAWS is characterized by prolonged symptoms including anhedonia, fatigue, and cravings lasting weeks to months after acute withdrawal resolves.

Question 3: According to Marlatt's relapse prevention model, which factor is considered the most proximal trigger for relapse?

High-risk situation
Negative emotional state
Abstinence violation effect (Correct answer)
Decreased self-efficacy

Correct answer: Abstinence violation effect

The abstinence violation effect — guilt and cognitive dissonance after a lapse — is the most proximal factor leading from a lapse to full relapse in Marlatt's model.

Question 4: Which pharmacological agent is FDA-approved for preventing relapse specifically in alcohol use disorder by reducing craving through glutamate modulation?

Acamprosate (Correct answer)
Naltrexone
Disulfiram
Topiramate

Correct answer: Acamprosate

Acamprosate reduces glutamate hyperactivity during protracted abstinence, decreasing craving and supporting relapse prevention in alcohol use disorder.

Question 5: In the Transtheoretical Model, a patient who acknowledges a substance use problem and intends to change within the next 6 months is in which stage?

Contemplation (Correct answer)
Preparation
Action
Pre-contemplation

Correct answer: Contemplation

Contemplation is defined by awareness of a problem and intention to change within 6 months but without commitment to immediate action.

Question 6: A patient with opioid use disorder on buprenorphine maintenance reports a relapse after losing their job. Which intervention is MOST appropriate at this point?

Continue buprenorphine and address psychosocial stressors (Correct answer)
Discontinue buprenorphine and refer to detox
Increase buprenorphine dose immediately without assessment
Switch to methadone without further evaluation

Correct 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.

Question 7: Which self-help recovery program uses a secular, evidence-based approach and teaches rational emotive behavior therapy principles rather than spiritual steps?

SMART Recovery (Correct answer)
Narcotics Anonymous
Celebrate Recovery
LifeRing Secular Recovery

Correct answer: SMART Recovery

SMART Recovery (Self-Management and Recovery Training) uses rational emotive behavior therapy and motivational techniques instead of the 12-step spiritual model.

Question 8: Which neurotransmitter system's dysregulation is most responsible for the increased stress sensitivity and negative affect that drive relapse during early recovery?

Corticotropin-releasing factor (CRF) (Correct answer)
Serotonin
Acetylcholine
GABA

Correct answer: Corticotropin-releasing factor (CRF)

CRF dysregulation in the extended amygdala underlies negative emotional states during withdrawal, driving stress-induced relapse in the dark side of addiction.

Question 9: A patient in recovery from alcohol use disorder identifies 'driving past a bar' as a trigger for cravings. The most appropriate coping strategy from CBT would be:

Urge surfing and route planning avoidance (Correct answer)
Immediate naltrexone dose
Calling their sponsor immediately every time
Cognitive restructuring of their drinking history

Correct answer: Urge surfing and route planning avoidance

Urge surfing teaches the patient to ride out the craving while route planning (stimulus control) reduces exposure to the conditioned cue.

Question 10: What is the primary mechanism by which contingency management improves abstinence rates in stimulant use disorder?

Operant conditioning through positive reinforcement of abstinence (Correct answer)
Classical conditioning to extinguish drug cues
Cognitive restructuring of drug-related beliefs
Social learning through peer modeling

Correct answer: Operant conditioning through positive reinforcement of abstinence

Contingency management uses vouchers or prizes as positive reinforcers contingent on drug-negative urine screens, leveraging operant conditioning principles.

Question 11: Which of the following best describes 'recovery capital' in addiction medicine?

Internal and external resources that support sustained recovery (Correct answer)
Financial compensation for treatment costs
Insurance coverage for medications
Capital funding for recovery residences

Correct answer: Internal and external resources that support sustained recovery

Recovery capital encompasses personal, social, community, and cultural resources that facilitate recovery and reduce relapse risk.

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

Encouraging acceptance of powerlessness and participation in AA meetings (Correct answer)
Teaching behavioral coping skills for relapse prevention
Providing motivational interviewing to enhance readiness
Using cognitive restructuring to challenge drinking beliefs

Correct 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.

Question 13: Which recovery residence level provides the highest structure with on-site paid staff, clinical services, and is most appropriate for patients with co-occurring mental health disorders?

Level IV (therapeutic communities/residential treatment) (Correct answer)
Level I (peer-run sober living)
Level II (monitored sober living)
Level III (supervised sober living)

Correct answer: Level IV (therapeutic communities/residential treatment)

Level IV recovery residences offer the most intensive support with clinical staffing, making them appropriate for those with complex co-occurring conditions.

Question 14: During mindfulness-based relapse prevention (MBRP), patients are specifically trained to respond to cravings by:

Observing cravings with non-judgmental awareness rather than acting on them (Correct answer)
Suppressing all thoughts about substances
Immediately using distraction techniques
Calling a support person every time a craving occurs

Correct answer: Observing cravings with non-judgmental awareness rather than acting on them

MBRP teaches mindful awareness of cravings as transient mental events, reducing automatic reactive behavior through non-judgmental observation.

Question 15: 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:

Emotional relapse (Correct answer)
Mental relapse
Physical relapse
Behavioral 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 16: Which duration of naltrexone therapy has the strongest evidence for preventing alcohol relapse after achieving abstinence?

At least 12 weeks (Correct answer)
At least 3 days
Exactly 30 days
Until the first drink

Correct answer: At least 12 weeks

Clinical trials and guidelines support a minimum of 12 weeks of naltrexone for alcohol use disorder, with many patients benefiting from extended therapy.

Question 17: Which of the following is a key component of Medication-Assisted Treatment (MAT) that differentiates it from detoxification alone?

Integration of pharmacotherapy with behavioral health services over time (Correct answer)
Use of higher medication doses for rapid detox
Administration in a hospital setting only
Restriction to patients with no prior treatment history

Correct answer: Integration of pharmacotherapy with behavioral health services over time

MAT combines FDA-approved medications with counseling and behavioral therapies to treat the whole person, sustaining recovery beyond initial detoxification.

Question 18: A patient with alcohol use disorder has been sober for 4 months and reports vivid dreams about drinking, irritability, and difficulty concentrating. These symptoms are most consistent with:

Protracted abstinence syndrome (Correct answer)
Alcohol-induced persisting dementia
Wernicke encephalopathy
Korsakoff syndrome

Correct answer: Protracted abstinence syndrome

Protracted abstinence syndrome (also called PAWS) causes prolonged neurological symptoms including sleep disturbance, mood changes, and cognitive difficulties for months after acute withdrawal.

Question 19: According to ASAM criteria, which dimension is specifically evaluated when assessing a patient's 'readiness to change' for treatment placement?

Dimension 4: Readiness to Change (Correct answer)
Dimension 2: Biomedical Conditions
Dimension 5: Relapse Potential
Dimension 6: Living Environment

Correct answer: Dimension 4: Readiness to Change

ASAM Dimension 4 specifically assesses the patient's readiness, interest, and commitment to change and engagement in treatment.

Question 20: Which of the following protective factors has the strongest evidence for preventing relapse in patients with opioid use disorder?

Continued maintenance with buprenorphine or methadone (Correct answer)
Completion of a 28-day residential program
Regular attendance at Narcotics Anonymous
Stable housing alone

Correct answer: Continued maintenance with buprenorphine or methadone

MOUD with buprenorphine or methadone reduces relapse risk, overdose mortality, and criminal activity more than any single psychosocial intervention alone.

Question 21: In motivational interviewing, the clinician's use of 'change talk' elicitation is primarily intended to:

Increase the patient's own verbal arguments for changing (Correct answer)
Persuade the patient by listing benefits of sobriety
Confront denial and break down resistance
Provide education about addiction as a disease

Correct answer: Increase the patient's own verbal arguments for changing

MI focuses on evoking the patient's own motivation through change talk (DARN-CAT), as self-generated arguments for change are more persuasive than clinician-delivered information.

Addiction Medicine Certification Addiction Medicine Recovery & Relapse Prevention

Which cognitive-behavioral therapy technique is specifically designed to help patients identify high-risk situations for relapse?

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