SAP Substance Abuse Diagnosis 3 — Questions and Answers
Question 1: Under DOT 49 CFR Part 40, a SAP must be qualified as which of the following to conduct evaluations?
- A licensed physician only
- A credentialed professional such as a licensed counselor, social worker, psychologist, or physician with appropriate training (Correct answer)
- Any HR professional trained in drug testing policy
- A law enforcement officer certified in substance abuse detection
Correct answer: A credentialed professional such as a licensed counselor, social worker, psychologist, or physician with appropriate training
DOT regulations specify that SAPs must be licensed or certified professionals (physicians, psychologists, social workers, counselors, or EAP professionals) with specific knowledge of alcohol and drug abuse disorders.
Question 2: Which assessment tool is commonly used by SAPs to screen for alcohol use disorder severity and readiness for change?
- MMPI-2
- AUDIT (Alcohol Use Disorders Identification Test) (Correct answer)
- Beck Depression Inventory
- CAGE questionnaire alone without clinical interview
Correct answer: AUDIT (Alcohol Use Disorders Identification Test)
The AUDIT is a validated 10-item screening tool developed by the WHO that SAPs commonly use to assess alcohol use disorder severity.
Question 3: A truck driver reports they only drink on weekends but consumed 15 drinks over two days. The SAP's diagnostic conclusion should be based on:
- The driver's self-reported intent, since they avoid weekday drinking
- A full clinical evaluation including quantity, frequency, and functional impact over the past 12 months (Correct answer)
- The number of drinks alone, which confirms severe AUD automatically
- Only the DOT violation record without further clinical inquiry
Correct answer: A full clinical evaluation including quantity, frequency, and functional impact over the past 12 months
Diagnosis requires a comprehensive clinical evaluation examining the full pattern of use, consequences, and DSM-5 criteria—not a single data point.
Question 4: Tolerance in the context of a Substance Use Disorder diagnosis is defined as:
- The legal blood alcohol limit set by DOT regulations
- Needing markedly increased amounts of a substance to achieve intoxication, or diminished effect with the same amount (Correct answer)
- The ability to function normally without using a substance
- A physician's approval to use a controlled substance at work
Correct answer: Needing markedly increased amounts of a substance to achieve intoxication, or diminished effect with the same amount
Tolerance is defined in DSM-5 as requiring more of the substance to achieve the same effect, or experiencing less effect from the same amount over time.
Question 5: In diagnosing Opioid Use Disorder for a DOT safety-sensitive employee, the SAP must distinguish between OUD and:
- Opioid intoxication disorder and legitimate prescribed opioid use with no loss of control (Correct answer)
- Nicotine Use Disorder, which has the same diagnostic criteria
- Stimulant Use Disorder, which presents identically
- Cannabis Use Disorder, as both involve the same receptor systems
Correct answer: Opioid intoxication disorder and legitimate prescribed opioid use with no loss of control
The SAP must determine whether opioid use meets DSM-5 SUD criteria or whether it represents clinically supervised use without impaired control.
Question 6: Which term describes the appearance of withdrawal symptoms when a substance is reduced or stopped, serving as a DSM-5 SUD criterion?
- Tolerance
- Withdrawal (Correct answer)
- Craving
- Intoxication
Correct answer: Withdrawal
Withdrawal is a substance-specific syndrome that emerges when use is discontinued or reduced, and its presence is one of the DSM-5 pharmacological criteria for SUD.
Question 7: A SAP diagnoses an employee with No Diagnosis. Under DOT regulations, what is the appropriate next step?
- The SAP must still recommend 6 months of follow-up testing
- The SAP provides a return-to-duty recommendation and follow-up testing plan based on clinical judgment (Correct answer)
- The employee automatically returns to duty with no further requirements
- The employer must dispute the SAP finding with a Medical Review Officer
Correct answer: The SAP provides a return-to-duty recommendation and follow-up testing plan based on clinical judgment
Even when no SUD is diagnosed, the SAP provides a return-to-duty recommendation and a follow-up testing plan appropriate to the clinical picture.
SAP Substance Abuse Diagnosis 3
Under DOT 49 CFR Part 40, a SAP must be qualified as which of the following to conduct evaluations?