Addiction Medicine Certification Addiction Medicine Recovery & Relapse Prevention 3 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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.
Addiction Medicine Certification Addiction Medicine Recovery & Relapse Prevention 3
Which neurotransmitter system's dysregulation is most responsible for the increased stress sensitivity and negative affect that drive relapse during early recovery?