Addiction Medicine Certification Treatment Planning & Protocols 2 — Questions and Answers
Question 1: A patient with opioid use disorder declines buprenorphine but agrees to extended-release naltrexone. Which prerequisite must be met before initiating XR-naltrexone?
- Complete 7–10 days of opioid abstinence to avoid precipitated withdrawal (Correct answer)
- Obtain a liver biopsy to rule out hepatic fibrosis
- Taper methadone to zero before the induction visit
- Enroll in a residential program for a minimum of 30 days
Correct answer: Complete 7–10 days of opioid abstinence to avoid precipitated withdrawal
XR-naltrexone requires full opioid detoxification (typically 7–10 days abstinence) to prevent precipitated withdrawal.
Question 2: Which ASAM level of care is most appropriate for a patient who requires medically managed intensive inpatient services due to severe withdrawal and co-occurring psychiatric instability?
- Level 1.0 — Outpatient Services
- Level 3.1 — Clinically Managed Low-Intensity Residential
- Level 3.7 — Medically Monitored Intensive Inpatient
- Level 4.0 — Medically Managed Intensive Inpatient (Correct answer)
Correct answer: Level 4.0 — Medically Managed Intensive Inpatient
ASAM Level 4.0 provides 24-hour physician-managed care for patients with severe medical and psychiatric instability.
Question 3: Under the ASAM multidimensional assessment, Dimension 3 specifically evaluates which aspect of a patient's presentation?
- Readiness to change
- Emotional, behavioral, and cognitive conditions (Correct answer)
- Biomedical conditions and complications
- Recovery environment
Correct answer: Emotional, behavioral, and cognitive conditions
ASAM Dimension 3 assesses emotional, behavioral, and cognitive conditions or complications that may affect treatment.
Question 4: A patient with alcohol use disorder has a CIWA-Ar score of 18. Which treatment approach is most clinically appropriate?
- Reassure the patient and schedule outpatient follow-up in one week
- Initiate symptom-triggered benzodiazepine therapy in a medically supervised setting (Correct answer)
- Prescribe disulfiram immediately to deter drinking
- Administer oral naltrexone and discharge home
Correct answer: Initiate symptom-triggered benzodiazepine therapy in a medically supervised setting
A CIWA-Ar score of 15–20 indicates moderate-to-severe withdrawal requiring symptom-triggered benzodiazepines in a supervised setting.
Question 5: Which of the following best describes the role of contingency management in addiction treatment planning?
- Providing legal consequences when patients relapse to reinforce abstinence
- Using tangible rewards to reinforce drug-negative urine screens and treatment attendance (Correct answer)
- Restricting medication access unless the patient maintains perfect attendance
- Applying operant conditioning through punishment of non-compliant behaviors
Correct answer: Using tangible rewards to reinforce drug-negative urine screens and treatment attendance
Contingency management uses positive reinforcement — typically vouchers or prizes — to reward abstinence and prosocial behaviors.
Question 6: A pregnant patient presents with heroin use disorder. According to evidence-based guidelines, which is the preferred treatment?
- Medically supervised rapid detoxification
- Naltrexone extended-release injection
- Methadone or buprenorphine maintenance therapy (Correct answer)
- Abstinence-based residential treatment without pharmacotherapy
Correct answer: Methadone or buprenorphine maintenance therapy
Methadone or buprenorphine maintenance is the evidence-based standard of care for opioid use disorder in pregnancy; detoxification carries high relapse and fetal risk.
Question 7: Which statement about treatment matching in addiction medicine is most accurate?
- All patients with stimulant use disorder should start at the most intensive ASAM level regardless of severity
- Treatment intensity should be matched to patient severity across ASAM's six dimensions (Correct answer)
- Residential treatment is always superior to outpatient treatment for alcohol use disorder
- Motivational interviewing should be reserved only for patients with high readiness to change
Correct answer: Treatment intensity should be matched to patient severity across ASAM's six dimensions
The ASAM criteria guide treatment matching by assessing severity across six dimensions so the appropriate level of care is selected.
Addiction Medicine Certification Treatment Planning & Protocols 2
A patient with opioid use disorder declines buprenorphine but agrees to extended-release naltrexone.
Which prerequisite must be met before initiating XR-naltrexone?