Addiction Medicine Certification Addiction Medicine Treatment Planning 2 — Questions and Answers
Question 1: A patient with opioid use disorder has chronic pain and requests buprenorphine. Which treatment planning consideration is MOST important?
- Defer OUD treatment until pain is controlled
- Use a single agent that addresses both OUD and pain when possible (Correct answer)
- Prescribe full agonist opioids for pain alongside buprenorphine
- Refer exclusively to a pain specialist before initiating OUD treatment
Correct answer: Use a single agent that addresses both OUD and pain when possible
Buprenorphine is a partial agonist with analgesic properties and can address both OUD and chronic pain simultaneously, making it the preferred agent in co-occurring conditions.
Question 2: When developing a treatment plan for a patient with stimulant use disorder, which pharmacological approach has the strongest evidence base?
- Bupropion monotherapy
- Modafinil combined with contingency management
- No FDA-approved medications; behavioral therapies are primary (Correct answer)
- Naltrexone extended-release injection
Correct answer: No FDA-approved medications; behavioral therapies are primary
There are currently no FDA-approved medications for stimulant use disorder, making behavioral interventions such as contingency management the first-line treatment approach.
Question 3: A treatment plan for a patient with severe alcohol use disorder should include which level of care according to ASAM criteria when the patient has a history of alcohol withdrawal seizures?
- Outpatient detox with daily check-ins
- Standard outpatient treatment (Level 1)
- Medically managed intensive inpatient (Level 4) (Correct answer)
- Clinically managed residential (Level 3.5)
Correct answer: Medically managed intensive inpatient (Level 4)
A history of alcohol withdrawal seizures indicates high seizure risk, requiring medically managed intensive inpatient care (ASAM Level 4) for safe detoxification.
Question 4: Which motivational interviewing technique is MOST appropriate early in treatment planning when a patient is ambivalent about change?
- Confronting denial directly to break resistance
- Exploring and reflecting the patient's own reasons for change (Correct answer)
- Providing an expert-driven list of consequences of continued use
- Setting firm behavioral contracts with consequences for non-compliance
Correct answer: Exploring and reflecting the patient's own reasons for change
Reflecting the patient's own ambivalence and eliciting their intrinsic reasons for change is the core of motivational interviewing and is most effective during pre-contemplation and contemplation stages.
Question 5: A patient with opioid use disorder is pregnant. Which treatment planning decision is MOST supported by evidence?
- Taper opioids completely before the third trimester
- Initiate methadone or buprenorphine maintenance therapy (Correct answer)
- Defer all pharmacotherapy until after delivery
- Use naltrexone as the preferred agent to avoid neonatal exposure
Correct answer: Initiate methadone or buprenorphine maintenance therapy
Methadone and buprenorphine maintenance are the evidence-based standards of care for opioid use disorder in pregnancy, reducing maternal relapse and improving neonatal outcomes.
Question 6: When planning treatment for a patient with co-occurring PTSD and alcohol use disorder, which sequencing approach is currently recommended?
- Treat PTSD only after 6 months of sustained sobriety
- Treat AUD first, then begin trauma-focused therapy
- Integrate treatment for both conditions concurrently (Correct answer)
- Prioritize alcohol detox, then refer entirely to mental health
Correct answer: Integrate treatment for both conditions concurrently
Concurrent integrated treatment of co-occurring PTSD and AUD produces better outcomes than sequential approaches, as each condition reinforces the other.
Question 7: A treatment plan includes extended-release naltrexone for alcohol use disorder. Which patient factor would be a contraindication to initiating this medication?
- Current moderate alcohol use
- History of opioid use disorder
- Active opioid dependence or recent opioid use (Correct answer)
- Elevated liver enzymes (ALT 2x normal)
Correct answer: Active opioid dependence or recent opioid use
Naltrexone is an opioid antagonist and will precipitate acute withdrawal in patients with current opioid dependence; patients must be opioid-free for 7–10 days before initiation.
Addiction Medicine Certification Addiction Medicine Treatment Planning 2
A patient with opioid use disorder has chronic pain and requests buprenorphine.
Which treatment planning consideration is MOST important?