ASAM EXAM QUESTIONS AND ANSWERS
100% PASS 2026 EDITION
1. A 32-year-old woman is being evaluated for alcoholism. This is her first time in treatment. She
has a 15-year history of alcohol dependence. Which of the following is the most appropriate
medication? - ANS Naltrexone
2. A 14-year-old boy comes to the office for an annual examination. During the interview, he
tells his physician that he has switched from smoking cigarettes to using smokeless tobacco
because he does not want to get lung cancer. The physician should tell the patient that he is
now at increased risk for cancer of which of the following? - ANS Esophageal
3. A 32-year-old woman comes to the office seeking assistance with smoking cessation. She has
smoked two packs of cigarettes daily for the past eight years. She has attempted to quit twice
before but was unable to overcome the withdrawal symptoms. She is using a nicotine
transdermal system to assist her in smoking cessation. Which of the following is a side effect she
should still expect to experience during her withdrawal of nicotine? - ANS Impaired reaction
time
4. A 42-year-old physician who specializes in ear, nose, and throat conditions is being
interviewed for a position by a hospital. She has active licenses in Arizona, Idaho, and Missouri
(her last place of residence for seven years). The training listed on her CV received has been
verified by a primary source. The National Data Bank contains no adverse records. Which of the
following is troublesome to require? - ANS Polygraph test
5. A 45-year-old injection drug user was started on methadone maintenance one month prior to
his current hospitalization for pneumonia. On a routine inpatient electrocardiogram, he has a
prolonged QT interval. In addition to his methadone dose, which of the following factors
increases his risk for developing an arrhythmia? - ANS Hypokalemia
6. A 30-year-old woman began taking alprazolam 0.25 mg four times daily two weeks ago for
generalized anxiety disorder (GAD). She now has increased sedation as treatment continues. For
this patient, select the most appropriate term: - ANS Sensitization
@2026 EDITION ALLRIGHT RESERVED 1
,7. A 45-year-old woman who has been taking alprazolam 0.5 mg four times daily for GAD
ruminates about the next dose beginning two hours after the last dose. For this patient, select
the most appropriate term: - ANS Pseudowithdrawal
8. A 45-year-old man took alprazolam for GAD for one year. He was weaned off the medication
over a three-month period. Two weeks after complete cessation, he notices increased worry.
For this patient, select the most appropriate term: - ANS Symptom recurrence (not true
withdrawal)
9. A 45-year-old man was placed on alprazolam 0.25 mg three times daily for GAD and
treatment was successful. He was tapered off of the medication over three months. One week
after complete cessation, he is tormented by anxiety and is sleeping only two hours per night.
For this patient, select the most appropriate term: - ANS Rebound (not true withdrawal)
10. A 36-year-old man who has a 20-year history of smoking cigarettes comes to the office for
counseling about smoking cessation. He has heard that "light" cigarettes may be safer and less
addictive and asks whether they could help him stop smoking. Which of the following
statements about light cigarettes is supported by scientific evidence? A: Smokers adjust their
current nicotine level by adjusting puffing habits - ANS Smokers adjust their current nicotine
level by adjusting puffing habits
11. A 50-year-old man with alcohol dependency is hospitalized with signs of acute withdrawal.
Which of the following drugs should be administered to prevent Wernicke's encephalopathy in
this patient? - ANS thiamine
12. A 25-year-old man is brought to the emergency department by his partner because of a
two-day history of agitation. The patient says he left his work early because his boss was spying
on him. His speech is pressured. He says he has been taking medication for the past three
months. His partner reports that the patient had been taking more than the prescribed dose
because he was preparing for a college examination. Which of the following medications is the
most likely cause of his symptoms? - ANS methylphenidate
13. A 45-year-old man has jaundice caused by chronic alcohol abuse. His physician spends
several minutes asking him about his drinking habits and encourages him to consider stopping
drinking. The patient is not ready to contemplate stopping at that visit, but the physician brings
up the topic in a nonthreatening manner at subsequent visits until the patient decides to take
some action to stop drinking. The physician then offers the patient several choices for
accomplishing that goal. This framework of brief interventions to promote healthful behavior is
known as which of the following? - ANS motivational interviewing
@2026 EDITION ALLRIGHT RESERVED 2
,14. A 17-year-old boy comes to the office for a sports physical examination. When asked about
his drug and alcohol use, he discloses that he recently started smoking marijuana. Which of the
following is the most likely source from which he obtained the marijuana? - ANS Friends
15. A retired physician works eight hours per week at a private general medicine clinic in a rural
community. The practice serves primarily economically stable, Medicare-eligible patients.
Recently, the physician learned and implemented a new diagnostic test with a sensitivity of 91%
and specificity of 94% to diagnose a disease. However, one of the physician's patients believes
he has been incorrectly diagnosed as a result of this test and retains a lawyer to file a suit
against the physician. The successful court argument against the use of the test by the physician
is most likely based on which of the following? - ANS Cases in the population per year
(prevalence)
16. Which of the following disorders would most likely benefit from treatment with cannabinoid
type 1 (CB1) receptor antagonists? - ANS Obesity(ref : Trends Neurosci. 2006 Feb 14; Links
Involvement of the endocannabinoid system in drug addiction. Maldonado R, Valverde O,
Berrendero F. 6:Gadde KM. Endocannabinoid receptor antagonists and other emerging pharma-
cological strategies for weight reduction. Curr Drug Targets Cardiovasc Haematol Disord. 2005
Dec;5(6):549-56.)
17. A patient comes to the emergency department because he is "hearing colors and smelling
sounds." He reports taking an unknown substance at a party several hours ago. Vital signs show
increased pulse rate and blood pressure. The patient is quite agitated and wants these effects to
go away. Which of the following drugs is most likely to cause these effects? - ANS Lysergic
acid diethylamide (LSD)
18. Which of the following neurotransmitters is most closely associated with the function of the
brain reward circuitry? - ANS Dopamine
19. A 19-year-old college student is brought to the emergency department after using drugs for
the first time. He says he initially felt as if he was "melting through the floor," but now feels as if
he is "floating through alternate realities." The experience lasts about one-half hour. Which of
the following substances is the most likely cause of his symptoms? - ANS Salvia(ref: Lange JE,
Reed MB, Croff JM, et al: College student use of Salvia divinorum. Drug Alcohol Depend
2008;94:263-266.)
20. Which of the following problems with alcohol is likely to be most common among patients
admitted in outpatient settings? - ANS at-risk drinking
21. A 25-year-old woman who has just given birth is concerned that her child has inherited a
predisposition for smoking. She and the child's father have recently quit smoking, but many of
their first- and second-degree family members smoke. The risk that this child will smoke based
@2026 EDITION ALLRIGHT RESERVED 3
, on genetic factors alone is closest to what percentage? - ANS 60%(ref: Reference: Sullivan PF,
Kendler KS: The genetic epidemiology of smoking. Nicotine Tob Res 1999;1 Suppl 2: S51-S57.)
22. A 23-year-old man is currently undergoing treatment for heroin dependence. He reports
that his heroin dealer gave him a small supply while he was experiencing withdrawal symptoms.
The patient will most likely perceive heroin as which of the following? - ANS negative
reinforcement (ref: Molecular Neuropharmacology, Nestler, et al. 2001 p. 356)
23. A 25-year-old man is abusing a drug of choice daily and at relatively consistent amounts.
Which of the following drugs is he most likely using? - ANS heroin (ref: Molecular
Neuropharmacology, Nestler, et al. 2001 p. 361)
24. A 48-year-old man comes for consultation after seeing light trails behind moving objects and
having the feeling that he could "smell colors" around him. These symptoms first occurred one
day after he began lifting weights to relieve work-related stress. He says that he has used
lysergic acid diethylamide (LSD), cocaine, gamma-hydroxybutyrate (GHB), kava kava, and
toluene in the past. Which of the following drugs is most likely responsible? - ANS LSD (ref:
Weaver MF, Schnoll SH. Hallucinogens and club drugs. In M. Galanter & H. D. Klebert (Eds.),
Textbook of Substance Abuse Treatment, 4th Ed., Washington, D.C.: American Psychiatric Press,
pp 191-200, 2008)
25. A 48-year-old man comes for consultation after seeing light trails behind moving objects and
having the feeling that he could "smell colors" around him. These symptoms first occurred one
day after he began lifting weights to relieve work-related stress. He says that he has used
lysergic acid diethylamide (LSD), cocaine, gamma-hydroxybutyrate (GHB), kava kava, and
toluene in the past. Within which of the following time frames did this patient most likely use
this drug? - ANS one year (same ref as 23)
26. A 26-year-old man is brought to the emergency department by his roommates two hours
after he became agitated and confused. They report that he was not drinking alcohol or using
illicit drugs prior to the change in behavior. For the past six months, he has been taking a liquid
supplement obtained from a trainer at his gym. He had used the supplement every two to four
hours daily, but stopped six hours ago because he had begun to need more of it to achieve its
calming effect and he was unable to fall asleep without using it. He has no history of serious
illness and takes no other medications. The patient is agitated and restless. He says he hears
voices he does not recognize and sees things "moving that are not moving." His pulse is
104/min and blood pressure is 170/100 mm Hg. Physical examination shows vertical nystagmus
and a fine tremor in both of his upper extremities. He is unable to sit through the examinatio -
ANS begin high-dose diazepam (ref: Graham et al. Principles of Addiction Medicine: Third
Edition. 2003, 686-690)
27. A 26-year-old man is brought to the emergency department by his roommates two hours
after he became agitated and confused. They report that he was not drinking alcohol or using
@2026 EDITION ALLRIGHT RESERVED 4
100% PASS 2026 EDITION
1. A 32-year-old woman is being evaluated for alcoholism. This is her first time in treatment. She
has a 15-year history of alcohol dependence. Which of the following is the most appropriate
medication? - ANS Naltrexone
2. A 14-year-old boy comes to the office for an annual examination. During the interview, he
tells his physician that he has switched from smoking cigarettes to using smokeless tobacco
because he does not want to get lung cancer. The physician should tell the patient that he is
now at increased risk for cancer of which of the following? - ANS Esophageal
3. A 32-year-old woman comes to the office seeking assistance with smoking cessation. She has
smoked two packs of cigarettes daily for the past eight years. She has attempted to quit twice
before but was unable to overcome the withdrawal symptoms. She is using a nicotine
transdermal system to assist her in smoking cessation. Which of the following is a side effect she
should still expect to experience during her withdrawal of nicotine? - ANS Impaired reaction
time
4. A 42-year-old physician who specializes in ear, nose, and throat conditions is being
interviewed for a position by a hospital. She has active licenses in Arizona, Idaho, and Missouri
(her last place of residence for seven years). The training listed on her CV received has been
verified by a primary source. The National Data Bank contains no adverse records. Which of the
following is troublesome to require? - ANS Polygraph test
5. A 45-year-old injection drug user was started on methadone maintenance one month prior to
his current hospitalization for pneumonia. On a routine inpatient electrocardiogram, he has a
prolonged QT interval. In addition to his methadone dose, which of the following factors
increases his risk for developing an arrhythmia? - ANS Hypokalemia
6. A 30-year-old woman began taking alprazolam 0.25 mg four times daily two weeks ago for
generalized anxiety disorder (GAD). She now has increased sedation as treatment continues. For
this patient, select the most appropriate term: - ANS Sensitization
@2026 EDITION ALLRIGHT RESERVED 1
,7. A 45-year-old woman who has been taking alprazolam 0.5 mg four times daily for GAD
ruminates about the next dose beginning two hours after the last dose. For this patient, select
the most appropriate term: - ANS Pseudowithdrawal
8. A 45-year-old man took alprazolam for GAD for one year. He was weaned off the medication
over a three-month period. Two weeks after complete cessation, he notices increased worry.
For this patient, select the most appropriate term: - ANS Symptom recurrence (not true
withdrawal)
9. A 45-year-old man was placed on alprazolam 0.25 mg three times daily for GAD and
treatment was successful. He was tapered off of the medication over three months. One week
after complete cessation, he is tormented by anxiety and is sleeping only two hours per night.
For this patient, select the most appropriate term: - ANS Rebound (not true withdrawal)
10. A 36-year-old man who has a 20-year history of smoking cigarettes comes to the office for
counseling about smoking cessation. He has heard that "light" cigarettes may be safer and less
addictive and asks whether they could help him stop smoking. Which of the following
statements about light cigarettes is supported by scientific evidence? A: Smokers adjust their
current nicotine level by adjusting puffing habits - ANS Smokers adjust their current nicotine
level by adjusting puffing habits
11. A 50-year-old man with alcohol dependency is hospitalized with signs of acute withdrawal.
Which of the following drugs should be administered to prevent Wernicke's encephalopathy in
this patient? - ANS thiamine
12. A 25-year-old man is brought to the emergency department by his partner because of a
two-day history of agitation. The patient says he left his work early because his boss was spying
on him. His speech is pressured. He says he has been taking medication for the past three
months. His partner reports that the patient had been taking more than the prescribed dose
because he was preparing for a college examination. Which of the following medications is the
most likely cause of his symptoms? - ANS methylphenidate
13. A 45-year-old man has jaundice caused by chronic alcohol abuse. His physician spends
several minutes asking him about his drinking habits and encourages him to consider stopping
drinking. The patient is not ready to contemplate stopping at that visit, but the physician brings
up the topic in a nonthreatening manner at subsequent visits until the patient decides to take
some action to stop drinking. The physician then offers the patient several choices for
accomplishing that goal. This framework of brief interventions to promote healthful behavior is
known as which of the following? - ANS motivational interviewing
@2026 EDITION ALLRIGHT RESERVED 2
,14. A 17-year-old boy comes to the office for a sports physical examination. When asked about
his drug and alcohol use, he discloses that he recently started smoking marijuana. Which of the
following is the most likely source from which he obtained the marijuana? - ANS Friends
15. A retired physician works eight hours per week at a private general medicine clinic in a rural
community. The practice serves primarily economically stable, Medicare-eligible patients.
Recently, the physician learned and implemented a new diagnostic test with a sensitivity of 91%
and specificity of 94% to diagnose a disease. However, one of the physician's patients believes
he has been incorrectly diagnosed as a result of this test and retains a lawyer to file a suit
against the physician. The successful court argument against the use of the test by the physician
is most likely based on which of the following? - ANS Cases in the population per year
(prevalence)
16. Which of the following disorders would most likely benefit from treatment with cannabinoid
type 1 (CB1) receptor antagonists? - ANS Obesity(ref : Trends Neurosci. 2006 Feb 14; Links
Involvement of the endocannabinoid system in drug addiction. Maldonado R, Valverde O,
Berrendero F. 6:Gadde KM. Endocannabinoid receptor antagonists and other emerging pharma-
cological strategies for weight reduction. Curr Drug Targets Cardiovasc Haematol Disord. 2005
Dec;5(6):549-56.)
17. A patient comes to the emergency department because he is "hearing colors and smelling
sounds." He reports taking an unknown substance at a party several hours ago. Vital signs show
increased pulse rate and blood pressure. The patient is quite agitated and wants these effects to
go away. Which of the following drugs is most likely to cause these effects? - ANS Lysergic
acid diethylamide (LSD)
18. Which of the following neurotransmitters is most closely associated with the function of the
brain reward circuitry? - ANS Dopamine
19. A 19-year-old college student is brought to the emergency department after using drugs for
the first time. He says he initially felt as if he was "melting through the floor," but now feels as if
he is "floating through alternate realities." The experience lasts about one-half hour. Which of
the following substances is the most likely cause of his symptoms? - ANS Salvia(ref: Lange JE,
Reed MB, Croff JM, et al: College student use of Salvia divinorum. Drug Alcohol Depend
2008;94:263-266.)
20. Which of the following problems with alcohol is likely to be most common among patients
admitted in outpatient settings? - ANS at-risk drinking
21. A 25-year-old woman who has just given birth is concerned that her child has inherited a
predisposition for smoking. She and the child's father have recently quit smoking, but many of
their first- and second-degree family members smoke. The risk that this child will smoke based
@2026 EDITION ALLRIGHT RESERVED 3
, on genetic factors alone is closest to what percentage? - ANS 60%(ref: Reference: Sullivan PF,
Kendler KS: The genetic epidemiology of smoking. Nicotine Tob Res 1999;1 Suppl 2: S51-S57.)
22. A 23-year-old man is currently undergoing treatment for heroin dependence. He reports
that his heroin dealer gave him a small supply while he was experiencing withdrawal symptoms.
The patient will most likely perceive heroin as which of the following? - ANS negative
reinforcement (ref: Molecular Neuropharmacology, Nestler, et al. 2001 p. 356)
23. A 25-year-old man is abusing a drug of choice daily and at relatively consistent amounts.
Which of the following drugs is he most likely using? - ANS heroin (ref: Molecular
Neuropharmacology, Nestler, et al. 2001 p. 361)
24. A 48-year-old man comes for consultation after seeing light trails behind moving objects and
having the feeling that he could "smell colors" around him. These symptoms first occurred one
day after he began lifting weights to relieve work-related stress. He says that he has used
lysergic acid diethylamide (LSD), cocaine, gamma-hydroxybutyrate (GHB), kava kava, and
toluene in the past. Which of the following drugs is most likely responsible? - ANS LSD (ref:
Weaver MF, Schnoll SH. Hallucinogens and club drugs. In M. Galanter & H. D. Klebert (Eds.),
Textbook of Substance Abuse Treatment, 4th Ed., Washington, D.C.: American Psychiatric Press,
pp 191-200, 2008)
25. A 48-year-old man comes for consultation after seeing light trails behind moving objects and
having the feeling that he could "smell colors" around him. These symptoms first occurred one
day after he began lifting weights to relieve work-related stress. He says that he has used
lysergic acid diethylamide (LSD), cocaine, gamma-hydroxybutyrate (GHB), kava kava, and
toluene in the past. Within which of the following time frames did this patient most likely use
this drug? - ANS one year (same ref as 23)
26. A 26-year-old man is brought to the emergency department by his roommates two hours
after he became agitated and confused. They report that he was not drinking alcohol or using
illicit drugs prior to the change in behavior. For the past six months, he has been taking a liquid
supplement obtained from a trainer at his gym. He had used the supplement every two to four
hours daily, but stopped six hours ago because he had begun to need more of it to achieve its
calming effect and he was unable to fall asleep without using it. He has no history of serious
illness and takes no other medications. The patient is agitated and restless. He says he hears
voices he does not recognize and sees things "moving that are not moving." His pulse is
104/min and blood pressure is 170/100 mm Hg. Physical examination shows vertical nystagmus
and a fine tremor in both of his upper extremities. He is unable to sit through the examinatio -
ANS begin high-dose diazepam (ref: Graham et al. Principles of Addiction Medicine: Third
Edition. 2003, 686-690)
27. A 26-year-old man is brought to the emergency department by his roommates two hours
after he became agitated and confused. They report that he was not drinking alcohol or using
@2026 EDITION ALLRIGHT RESERVED 4
