NRCME Drug Abuse and Alcoholism 2 — Questions and Answers
Question 1: A CMV driver presents with a BAC of 0.02% during a random DOT alcohol test. What is the correct action?
- Immediate removal from safety-sensitive duty for at least 24 hours (Correct answer)
- Disqualify the driver permanently
- Allow the driver to continue driving with a warning
- Refer for SAP evaluation immediately
Correct answer: Immediate removal from safety-sensitive duty for at least 24 hours
A BAC of 0.02–0.039% requires removal from safety-sensitive function for at least 24 hours per DOT regulations.
Question 2: Which of the following best describes the CAGE questionnaire in the context of alcohol screening?
- A 4-item tool assessing Cut down, Annoyed, Guilty, and Eye-opener drinking behaviors (Correct answer)
- A 10-item tool measuring alcohol withdrawal severity
- A biochemical test measuring liver enzyme elevation
- A self-report tool measuring daily alcohol consumption in units
Correct answer: A 4-item tool assessing Cut down, Annoyed, Guilty, and Eye-opener drinking behaviors
The CAGE questionnaire uses four yes/no questions about cutting down, annoyance, guilt, and eye-openers to screen for alcohol use disorder.
Question 3: A truck driver reports using prescribed buprenorphine/naloxone (Suboxone) for opioid use disorder. Under FMCSA regulations, what is the driver's qualification status?
- Disqualified because opioid-based medications preclude CMV operation (Correct answer)
- Qualified if the prescribing physician certifies no side effects
- Qualified at the medical examiner's discretion after a trial period
- Disqualified only if driving a hazmat vehicle
Correct answer: Disqualified because opioid-based medications preclude CMV operation
FMCSA advisory criteria disqualify drivers using Schedule II or III opioids including buprenorphine, as they cannot meet the 'no current use of a controlled substance' standard.
Question 4: Which laboratory marker is most useful for detecting chronic heavy alcohol use over the past 2–4 weeks?
- Carbohydrate-deficient transferrin (CDT) (Correct answer)
- Blood alcohol concentration (BAC)
- Serum glucose
- Complete blood count (CBC)
Correct answer: Carbohydrate-deficient transferrin (CDT)
CDT is a sensitive and specific biomarker that reflects heavy alcohol consumption over the preceding 2–4 weeks.
Question 5: Under 49 CFR Part 382, what is the minimum waiting period before a driver who tested positive for drugs may return to safety-sensitive duty?
- Successful completion of SAP-directed evaluation and follow-up testing (Correct answer)
- 30 days of abstinence confirmed by self-report
- One negative return-to-duty test without SAP involvement
- 6 months of supervised driving with a qualified monitor
Correct answer: Successful completion of SAP-directed evaluation and follow-up testing
Drivers must complete the Substance Abuse Professional (SAP) evaluation, recommended treatment/education, and pass a return-to-duty test before resuming safety-sensitive functions.
Question 6: Which symptom is characteristic of alcohol withdrawal and distinguishes it from opioid withdrawal?
- Seizures and delirium tremens (Correct answer)
- Rhinorrhea and yawning
- Miosis and bradycardia
- Hypersomnia and urinary retention
Correct answer: Seizures and delirium tremens
Alcohol withdrawal can cause life-threatening seizures and delirium tremens (DTs), features not seen with opioid withdrawal.
Question 7: A driver's urine drug screen is reported as 'adulterated.' What does this indicate?
- A substance was added to the specimen to interfere with testing (Correct answer)
- The specimen was collected at an incorrect temperature
- The donor attempted to substitute a synthetic sample
- The laboratory chain of custody was broken
Correct answer: A substance was added to the specimen to interfere with testing
An adulterated specimen contains a substance not expected in human urine that was added to interfere with the drug test.
