ASAM Exam Question Bank
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? -
CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? -
CORRECT ANSWERS-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? - CORRECT ANSWERS-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: - CORRECT ANSWERS-Sensitization
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: - CORRECT ANSWERS-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: - CORRECT ANSWERS-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: - CORRECT ANSWERS-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 - CORRECT ANSWERS-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? -
CORRECT ANSWERS-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? -
CORRECT ANSWERS-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? -
CORRECT ANSWERS-motivational interviewing
,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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-Lysergic acid diethylamide
(LSD)
18. Which of the following neurotransmitters is most closely associated with the function of the brain
reward circuitry? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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 on genetic factors
alone is closest to what percentage? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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
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? -
CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? -
CORRECT ANSWERS-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? - CORRECT ANSWERS-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: - CORRECT ANSWERS-Sensitization
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: - CORRECT ANSWERS-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: - CORRECT ANSWERS-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: - CORRECT ANSWERS-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 - CORRECT ANSWERS-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? -
CORRECT ANSWERS-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? -
CORRECT ANSWERS-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? -
CORRECT ANSWERS-motivational interviewing
,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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-Lysergic acid diethylamide
(LSD)
18. Which of the following neurotransmitters is most closely associated with the function of the brain
reward circuitry? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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 on genetic factors
alone is closest to what percentage? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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
