Addiction Medicine Certification Addiction Medicine Treatment Planning 3 — Questions and Answers
Question 1: A patient with alcohol use disorder also takes benzodiazepines for anxiety. Which treatment planning principle should guide medication decisions?
- Continue benzodiazepines since anxiety is a comorbidity requiring treatment
- Taper benzodiazepines as part of the plan given cross-tolerance and misuse risk (Correct answer)
- Switch immediately to a full-dose benzodiazepine for alcohol withdrawal management
- Avoid any anxiolytic until alcohol use is fully resolved
Correct answer: Taper benzodiazepines as part of the plan given cross-tolerance and misuse risk
Benzodiazepines carry significant misuse potential in patients with alcohol use disorder due to cross-tolerance; a taper with transition to non-addictive anxiolytics (e.g., buspirone, SSRIs) is standard practice.
Question 2: Which element of the biopsychosocial assessment is MOST critical when determining the appropriate ASAM level of care?
- Patient's preferred treatment modality
- Severity across all six ASAM dimensions (Correct answer)
- Insurance coverage and benefit limits
- Geographic proximity to treatment facilities
Correct answer: Severity across all six ASAM dimensions
ASAM level-of-care determination is based on a multidimensional assessment across all six ASAM criteria dimensions, not patient preference or logistical factors alone.
Question 3: Contingency management is most effective when reinforcers are delivered in which manner?
- Monthly rewards based on overall treatment attendance
- Large bonuses provided at 90-day sobriety milestones
- Immediate, frequent, and escalating rewards for verified abstinence (Correct answer)
- Weekly group-based collective rewards for collective progress
Correct answer: Immediate, frequent, and escalating rewards for verified abstinence
Contingency management works through operant conditioning and is most effective when reinforcers are immediate, frequent, and increase in value with consecutive negative drug screens.
Question 4: A patient in methadone maintenance treatment requests a take-home dose. Which federal regulation governs the criteria for take-home privileges?
- DEA Schedule II dispensing rules only
- SAMHSA/CSAT federal opioid treatment program regulations (42 CFR Part 8) (Correct answer)
- State pharmacy board guidelines exclusively
- FDA prescribing label for methadone
Correct answer: SAMHSA/CSAT federal opioid treatment program regulations (42 CFR Part 8)
Take-home methadone privileges in opioid treatment programs are governed by 42 CFR Part 8, which sets federal criteria based on treatment duration, clinical stability, and absence of substance use.
Question 5: Which statement about the treatment of cannabis use disorder is MOST accurate?
- There are FDA-approved medications for cannabis withdrawal
- Cognitive-behavioral therapy and motivational enhancement are the primary evidence-based treatments (Correct answer)
- Withdrawal symptoms rarely require clinical management
- Long-term cannabis use does not result in a clinically significant withdrawal syndrome
Correct answer: Cognitive-behavioral therapy and motivational enhancement are the primary evidence-based treatments
CBT and motivational enhancement therapy are the most evidence-supported treatments for cannabis use disorder; no medications are currently FDA-approved for this indication.
Question 6: A treatment plan for alcohol use disorder includes acamprosate. This medication works primarily by:
- Blocking opioid receptors to reduce reward from alcohol
- Causing aversive reactions when alcohol is consumed
- Modulating glutamate and GABA systems to reduce protracted withdrawal symptoms (Correct answer)
- Reducing dopamine release in the nucleus accumbens
Correct answer: Modulating glutamate and GABA systems to reduce protracted withdrawal symptoms
Acamprosate modulates the glutamatergic and GABAergic systems that are dysregulated during protracted alcohol withdrawal, reducing cravings and supporting abstinence.
Question 7: When planning residential treatment for a patient with severe stimulant use disorder and unstable housing, which ASAM dimension is MOST relevant for determining level of care?
- Dimension 1: Acute intoxication/withdrawal
- Dimension 4: Readiness to change
- Dimension 6: Living environment (Correct answer)
- Dimension 3: Emotional/behavioral conditions
Correct answer: Dimension 6: Living environment
ASAM Dimension 6 addresses the living environment and social supports; unstable or high-risk housing often necessitates a higher level of residential care to provide a recovery-supportive environment.
Addiction Medicine Certification Addiction Medicine Treatment Planning 3
A patient with alcohol use disorder also takes benzodiazepines for anxiety.
Which treatment planning principle should guide medication decisions?