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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? - ANSNaltrexone
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? - ANSEsophageal
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? - ANSImpaired
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? - ANSPolygraph 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? - ANSHypokalemia
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: - ANSSensitization
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: - ANSPseudowithdrawal
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: - ANSSymptom
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: - ANSRebound (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 - ANSSmokers adjust their current nicotine
level by adjusting puffing habits
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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? - ANSthiamine
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? - ANSmethylphenidate
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? - ANSmotivational 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? -
ANSFriends
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? - ANSCases
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? - ANSObesity(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? -
ANSLysergic acid diethylamide (LSD)
18. Which of the following neurotransmitters is most closely associated with the function of
the brain reward circuitry? - ANSDopamine
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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? -
ANSSalvia(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? - ANSat-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? - ANS60%(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? -
ANSnegative 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? - ANSheroin (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? -
ANSLSD (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? - ANSone 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
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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 - ANSbegin 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
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." High-
dose diazepam is administered. The patient does not improve and he becomes increasingly
combative. He is subdued by hospital staff and restraints are applied. Which of the following
is the most - ANSpropofol (same ref as 25)
28. A randomized double blind study compared acamprosate to naltrexone in daily binge
drinkers who did not meet criteria for alcohol dependence or abuse. The investigators
concluded that naltrexone was superior to acamprosate because 50% of the naltrexone group
achieved continuous abstinence for the past four weeks of the trial compared to 25% of those
assigned to acamprosate. This is considered statistically significant (p=0.001). The
investigators considered the patients who dropped out of the study as those who continued to
drink. Abstinence rates were the same in both groups. This subsequent analysis is known as
which of the following? - ANSintention-to-treat
29. Meta-analyses are used to establish effectiveness for evidence-based addiction practice.
These analyses combine the results from several different clinical trials to arrive at estimates
of efficacy. Which of the following is the basic unit of analysis used most often in meta-
analyses? - ANSeffect size
30. A 29-year-old man is starting treatment for multidrug dependence. He has a history of
using heroin, marijuana, alcohol, methamphetamine, and cocaine. After five days of
abstinence, which of the following substances is most likely to be detectable in urine? -
ANSmarijuana
31. A physician learns that a pharmacist working at a regional US retail pharmacy chain used
by some of his patients has been stealing. The pharmacist has taken two pills from every
alprazolam prescription filled over the past two months and has sold them illegally for
recreational use. Which of the following is the most appropriate initial step by the physician?
- ANSReport the pharmacist to law enforcement authorities (ref: Federation of State Medical
Boards: Essentials of a Modern Medical Practice Act, 11th Edition. Federation of State
Medical Boards of the U.S., Inc. 2006.)
32. A 28-year-old man has been using a substance daily for the past six weeks and stops
abruptly. Ten hours after his last use, he develops irritability, agitation, depression, nausea,
and anorexia. He also has insomnia and a mild tremor. Most of his symptoms lessen after two
LATEST UPDATED 2026/ 2027 WITH
VERIFIED ANSWERS COMPLETE
ACTUAL AND AUTHENTIC EXAM
BRAND NEW STUDY GUIDE!
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? - ANSNaltrexone
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? - ANSEsophageal
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? - ANSImpaired
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? - ANSPolygraph 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? - ANSHypokalemia
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: - ANSSensitization
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: - ANSPseudowithdrawal
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: - ANSSymptom
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: - ANSRebound (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 - ANSSmokers adjust their current nicotine
level by adjusting puffing habits
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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? - ANSthiamine
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? - ANSmethylphenidate
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? - ANSmotivational 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? -
ANSFriends
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? - ANSCases
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? - ANSObesity(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? -
ANSLysergic acid diethylamide (LSD)
18. Which of the following neurotransmitters is most closely associated with the function of
the brain reward circuitry? - ANSDopamine
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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? -
ANSSalvia(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? - ANSat-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? - ANS60%(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? -
ANSnegative 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? - ANSheroin (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? -
ANSLSD (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? - ANSone 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
, COMPREHENSIVE ASAM EXAM Bank
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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 - ANSbegin 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
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." High-
dose diazepam is administered. The patient does not improve and he becomes increasingly
combative. He is subdued by hospital staff and restraints are applied. Which of the following
is the most - ANSpropofol (same ref as 25)
28. A randomized double blind study compared acamprosate to naltrexone in daily binge
drinkers who did not meet criteria for alcohol dependence or abuse. The investigators
concluded that naltrexone was superior to acamprosate because 50% of the naltrexone group
achieved continuous abstinence for the past four weeks of the trial compared to 25% of those
assigned to acamprosate. This is considered statistically significant (p=0.001). The
investigators considered the patients who dropped out of the study as those who continued to
drink. Abstinence rates were the same in both groups. This subsequent analysis is known as
which of the following? - ANSintention-to-treat
29. Meta-analyses are used to establish effectiveness for evidence-based addiction practice.
These analyses combine the results from several different clinical trials to arrive at estimates
of efficacy. Which of the following is the basic unit of analysis used most often in meta-
analyses? - ANSeffect size
30. A 29-year-old man is starting treatment for multidrug dependence. He has a history of
using heroin, marijuana, alcohol, methamphetamine, and cocaine. After five days of
abstinence, which of the following substances is most likely to be detectable in urine? -
ANSmarijuana
31. A physician learns that a pharmacist working at a regional US retail pharmacy chain used
by some of his patients has been stealing. The pharmacist has taken two pills from every
alprazolam prescription filled over the past two months and has sold them illegally for
recreational use. Which of the following is the most appropriate initial step by the physician?
- ANSReport the pharmacist to law enforcement authorities (ref: Federation of State Medical
Boards: Essentials of a Modern Medical Practice Act, 11th Edition. Federation of State
Medical Boards of the U.S., Inc. 2006.)
32. A 28-year-old man has been using a substance daily for the past six weeks and stops
abruptly. Ten hours after his last use, he develops irritability, agitation, depression, nausea,
and anorexia. He also has insomnia and a mild tremor. Most of his symptoms lessen after two
