Addiction Medicine Certification Patient Assessment & Evaluation 3 — Questions and Answers
Question 1: When assessing an adolescent for substance use, the CRAFFT tool's 'Car' item specifically screens for:
- Driving while under the influence or riding with an impaired driver (Correct answer)
- Access to vehicles that facilitate substance acquisition
- Family members who drive under the influence
- Risk of motor vehicle accidents due to coordination impairment
Correct answer: Driving while under the influence or riding with an impaired driver
The 'Car' item asks if the patient has ever ridden in a car driven by someone (including themselves) who was high or had been using alcohol or drugs.
Question 2: A patient presents with opioid use disorder and a comorbid generalized anxiety disorder. Per ASAM criteria, which dimension captures psychiatric comorbidity?
- Dimension 2: Biomedical Conditions
- Dimension 3: Emotional/Behavioral/Cognitive Conditions (Correct answer)
- Dimension 4: Readiness to Change
- Dimension 5: Relapse Potential
Correct answer: Dimension 3: Emotional/Behavioral/Cognitive Conditions
ASAM Dimension 3 encompasses emotional, behavioral, and cognitive conditions including co-occurring psychiatric diagnoses such as anxiety disorders.
Question 3: Which validated instrument specifically assesses opioid withdrawal severity for clinical monitoring and research?
- CIWA-Ar
- COWS (Correct answer)
- SOWS
- AUDIT
Correct answer: COWS
The Clinical Opiate Withdrawal Scale (COWS) is a validated clinician-rated tool measuring 11 signs and symptoms of opioid withdrawal.
Question 4: During a comprehensive substance use history, a patient reports 'chipping' heroin. This term refers to:
- Injecting heroin intradermally rather than intravenously
- Occasional or intermittent heroin use without daily dependence (Correct answer)
- Adulterating heroin with other substances
- Using broken pieces of compressed heroin tablets
Correct answer: Occasional or intermittent heroin use without daily dependence
Chipping describes sporadic, non-dependent heroin use and is clinically important because it may precede development of opioid use disorder.
Question 5: A patient's AUDIT score is 12. According to WHO AUDIT risk zone classification, this score places the patient in:
- Zone I: Low risk
- Zone II: Hazardous use
- Zone III: Harmful use (Correct answer)
- Zone IV: Probable dependence
Correct answer: Zone III: Harmful use
AUDIT scores of 8–15 indicate Zone II (hazardous) and 16–19 indicate Zone III (harmful); a score of 12 falls within Zone II hazardous drinking.
Question 6: In assessing a patient for stimulant use disorder, which pattern of use most distinguishes a use disorder from non-disordered stimulant use?
- Frequency of use exceeding three times per week
- Continued use despite significant psychosocial consequences (Correct answer)
- Preference for intranasal over oral route of administration
- Use of stimulants obtained without a prescription
Correct answer: Continued use despite significant psychosocial consequences
DSM-5 diagnosis of stimulant use disorder requires a maladaptive pattern causing clinically significant impairment, with continued use despite consequences being a core criterion.
Question 7: Which tool is most appropriate for assessing readiness to change in a patient who has just experienced an alcohol-related legal consequence?
- AUDIT-C
- URICA (University of Rhode Island Change Assessment) (Correct answer)
- DAST-10
- CIWA-Ar
Correct answer: URICA (University of Rhode Island Change Assessment)
URICA measures stages of change (precontemplation through maintenance) and is validated for use in patients court-referred or entering treatment after a crisis.
Addiction Medicine Certification Patient Assessment & Evaluation 3
When assessing an adolescent for substance use, the CRAFFT tool's 'Car' item specifically screens for: