ADM Cheat Sheet 2026

The 30 highest-yield ADM facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. When assessing a dual diagnosis patient, which factor is most important before diagnosing a primary psychiatric disorder? → A period of sobriety to clarify substance-free psychiatric status
2. What constitutes a boundary violation in professional practice? → Engaging in dual relationships that could impair professional judgment
3. A patient reports spending most of the day obtaining, using, and recovering from alcohol. Which DSM-5 criterion does this best exemplify? → A great deal of time spent
4. Extended-release naltrexone (Vivitrol) 380 mg IM is administered monthly. If a patient uses opioids during this period, what is the expected outcome? → Attenuation or blockade of opioid euphoria without precipitated withdrawal
5. A healthcare worker in an addiction medicine clinic tests positive for latent tuberculosis infection (LTBI). What is the recommended management? → Treat LTBI with isoniazid or rifampin-based regimen and allow continued work
6. What is the first step before implementing any treatment procedure? → Verify patient identity and obtain informed consent
7. Why is knowledge of the circulatory system important for practitioners? → It helps identify contraindications and understand treatment effects on blood flow
8. The rewarding properties of all major drugs of abuse ultimately converge on increased dopamine signaling in which specific region? → Nucleus accumbens (NAc) shell
9. How does maintaining proper credentials demonstrate regulatory compliance? → It proves the practitioner has met all requirements for legal practice
10. Why is continued care important in substance use recovery? → To maintain ongoing support and prevent relapse
11. Which finding most strongly suggests the presence of alcohol-induced liver disease during a physical examination? → Hepatomegaly with spider angiomata and asterixis
12. Why is continuing education important for maintaining ethical practice? → It ensures practitioners stay current with evolving standards and best practices
13. Which hepatic enzyme system is primarily responsible for first-pass metabolism of most drugs of abuse? → Cytochrome P450 (CYP) enzymes
14. Which ASAM level of care corresponds to a medically managed intensive inpatient program (Level 4)? → A hospital-based inpatient program with 24-hour physician management
15. The ASAM Criteria requires that level-of-care placement decisions be documented using assessment across how many dimensions? → Six
16. Neurobiological tolerance to opioids is primarily driven by which cellular mechanism? → Receptor desensitization and internalization
17. Which pharmacotherapy is FDA-approved for treating alcohol use disorder by blocking opioid receptors to reduce craving and reward? → Naltrexone
18. Which physiological process explains why repeated opioid use leads to tolerance? → Downregulation and desensitization of mu opioid receptors
19. Which ICD-10-CM code modifier indicates 'in sustained remission' for an alcohol use disorder diagnosis? → .21 (In sustained remission)
20. Which infectious disease screening is RECOMMENDED for all patients presenting with injection drug use? → HIV, hepatitis B, hepatitis C, and syphilis
21. Which aspect of the patient's substance use history is MOST important for determining the appropriate level of care? → Severity of use, prior treatment history, and current stability of living situation
22. What is the primary purpose of conducting a comprehensive patient assessment in Board Certified Addiction Medicine Specialist practice? → To establish baseline measurements and identify treatment needs
23. PET and fMRI studies consistently show which finding across most substance use disorders? → Reduced dopamine D2 receptor availability in the striatum
24. What documentation is required when equipment is replaced or upgraded? → Asset tracking records, disposal documentation, and updated operating procedures
25. Long-term substance use causes downregulation of dopamine D2 receptors, contributing primarily to which phenomenon? → Tolerance and anhedonia
26. Which specifier would be used for a patient with severe alcohol use disorder who has been incarcerated for 8 months and remains abstinent in that setting? → In a controlled environment
27. DEA regulations require that Schedule II controlled substances (including methadone) dispensed at an OTP be stored in which type of secured container? → A DEA-compliant safe or steel cabinet that is bolted to the floor or wall
28. The dorsolateral prefrontal cortex (dlPFC) is critically impaired in addiction. This impairment most directly results in which clinical manifestation? → Deficits in working memory and inhibitory control over drug-seeking
29. During motivational interviewing-based assessment, the clinician notices the patient is ambivalent about stopping cannabis use. The BEST next step is to: → Explore the patient's pros and cons of use using a decisional balance
30. A patient experiences intense urges to drink alcohol whenever they pass a bar. Which DSM-5 SUD criterion is most directly illustrated? → Craving or a strong desire to use