Addiction Medicine Certification Addiction Medicine Screening & Evaluation — Questions and Answers
Question 1: Which AUDIT-C score threshold is commonly used to indicate hazardous drinking in men?
- 3 or more
- 4 or more (Correct answer)
- 6 or more
- 8 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 2: The DAST-10 is a validated screening tool used to detect problems related to which substance category?
- Alcohol only
- Tobacco only
- Drug use (non-alcohol) (Correct answer)
- Both alcohol and drugs equally
Correct 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.
Question 3: When conducting a biopsychosocial assessment for substance use disorder, which domain specifically examines family history of addiction?
- Biological domain (Correct answer)
- Psychological domain
- Social domain
- Spiritual domain
Correct answer: Biological domain
The biological domain of a biopsychosocial assessment includes genetic predisposition and family history of substance use disorders.
Question 4: A patient scores 15 on the CIWA-Ar scale. Which clinical management is most appropriate?
- Outpatient monitoring only
- Reassure and discharge
- Inpatient medical detoxification (Correct answer)
- Naltrexone prescription
Correct answer: Inpatient medical detoxification
A CIWA-Ar score of 15 indicates moderate-to-severe alcohol withdrawal, requiring inpatient medical detoxification for safe management.
Question 5: 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?
- CAGE
- DAST-10
- Single-Item Drug Screen (Correct answer)
- CRAFFT
Correct 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.
Question 6: In the FRAMES model used during brief interventions, what does the letter 'R' stand for?
- Referral
- Responsibility (Correct answer)
- Resistance
- Reassessment
Correct answer: Responsibility
In FRAMES, 'R' stands for Responsibility, emphasizing that the patient is responsible for their own behavior change.
Question 7: Which laboratory finding is most suggestive of chronic heavy alcohol use when liver enzymes are elevated?
- AST/ALT ratio greater than 2:1 (Correct answer)
- ALT significantly higher than AST
- Isolated elevation of ALP
- Normal GGT with elevated ALT
Correct 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.
Question 8: Which component of the ASAM Criteria assesses a patient's readiness and interest in changing their substance use behavior?
- Dimension 1: Acute Intoxication/Withdrawal
- Dimension 3: Emotional/Behavioral Conditions
- Dimension 4: Readiness to Change (Correct answer)
- Dimension 6: Recovery Environment
Correct 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.
Question 9: A urine drug screen is positive for benzodiazepines, but the patient reports no prescription. Which next step is most appropriate?
- Immediately discharge the patient
- Order a confirmatory GC-MS test (Correct answer)
- Assume the screen is accurate and document misuse
- Repeat the immunoassay screen only
Correct 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.
Question 10: Which finding on a urine drug screen would most indicate possible sample adulteration?
- Creatinine of 30 mg/dL
- pH of 4.5
- Specific gravity of 1.001
- Creatinine below 2 mg/dL with normal color (Correct answer)
Correct 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.
Question 11: A patient with opioid use disorder is being evaluated for buprenorphine initiation. Which COWS score range best indicates readiness to begin induction?
- 1–4 (minimal withdrawal)
- 5–12 (mild withdrawal)
- 13–24 (moderate withdrawal) (Correct answer)
- 25+ (severe withdrawal)
Correct 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.
Question 12: Which of the following best describes the purpose of the 'Stages of Change' model in addiction screening?
- To quantify the severity of withdrawal symptoms
- To match the level of treatment intensity to the patient's needs
- To identify the patient's current readiness to change behavior (Correct answer)
- To assess comorbid psychiatric diagnoses
Correct 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.
Question 13: When screening a pregnant patient for substance use, which approach is recommended by ACOG and SAMHSA?
- Urine drug testing without consent at first visit
- Universal screening using a validated questionnaire at the first prenatal visit (Correct answer)
- Screen only patients with prior substance use history
- Wait until the second trimester to avoid distressing the patient
Correct 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.
Question 14: Which DSM-5 feature distinguishes a substance use disorder from substance dependence as defined in DSM-IV?
- DSM-5 requires a minimum of five criteria
- DSM-5 eliminated 'substance abuse' and 'dependence' as separate categories (Correct answer)
- DSM-5 added craving as a criterion and requires physical dependence
- DSM-5 includes a separate category for nicotine dependence only
Correct 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.
Question 15: 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?
- CIWA-Ar
- COWS (Correct answer)
- AUDIT
- CAGE
Correct answer: COWS
The Clinical Opiate Withdrawal Scale (COWS) is the validated tool to assess opioid withdrawal severity and guide treatment decisions post-stabilization.
Question 16: During a structured interview, a patient endorses using alcohol to 'relieve stress.' This most likely represents which concept in addiction evaluation?
- Physical dependence
- Negative reinforcement (Correct answer)
- Positive reinforcement
- Tolerance
Correct 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.
Question 17: Which of the following is considered the gold-standard screening approach recommended by NIDA for use in primary care settings?
- AUDIT only
- NIDA Quick Screen followed by NIDA-Modified ASSIST (Correct answer)
- CAGE followed by ASI
- SMAST-G for all patients
Correct 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.
Question 18: A patient's hair follicle drug test is positive for cocaine. Approximately how far back in time does this result reflect use?
- 24–72 hours
- Up to 1 week
- Up to 90 days (Correct answer)
- Up to 1 year
Correct 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.
Question 19: Which factor is most important when selecting a screening tool for a patient with low health literacy?
- Tool length and comprehensive coverage
- Reading level and question simplicity (Correct answer)
- Availability of biomarker confirmation
- Psychiatric comorbidity scoring
Correct 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.
Question 20: Which of the following best describes the purpose of ASAM Dimension 6 in the patient evaluation process?
- Assessing severity of acute withdrawal
- Identifying psychiatric comorbidities
- Evaluating the patient's living environment and social supports (Correct answer)
- Determining the patient's readiness to change
Correct 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.
Question 21: A clinician notices that a patient minimizes the impact of their drinking, saying 'I can stop anytime I want.' This statement most likely reflects which stage of the Transtheoretical Model?
- Contemplation
- Preparation
- Precontemplation (Correct answer)
- Maintenance
Correct answer: Precontemplation
The precontemplation stage is characterized by lack of awareness or minimization of the problem; the patient does not yet see the need to change.
