100+ Free ABPM Addiction Medicine Practice Questions

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Question 1

Score: 0/0

Per DSM-5-TR, how many of the 11 criteria (within a 12-month period) define a MODERATE substance use disorder?

2-3 criteria

4-5 criteria

6 or more criteria

1 criterion

to track

2026 Statistics

Key Facts: ABPM Addiction Medicine Exam

~200

Total MCQ Items

ABPM Addiction Medicine Subspecialty Examination

~8 hr

Total Exam Time

1-day computer-based test including breaks

~33%

AUD + OUD Combined Weight

Highest-yield domains on 2026 ABPM blueprint

$1,900

2026 Initial Cert Fee

ABPM subspecialty certification

12 mo

Required Fellowship

ACGME Addiction Medicine fellowship (practice pathway closed 2025)

Dec 2022

X-Waiver Eliminated

MAT Act — any DEA-registered prescriber can Rx buprenorphine for OUD

The ABPM Addiction Medicine exam is a 1-day computer-based test from the American Board of Preventive Medicine comprising ~200 single-best-answer MCQs over ~8 hours. The 2026 blueprint emphasizes opioid use disorder and MOUD (~18%), alcohol use disorder (~15%), screening/diagnosis (~10%), stimulants (~8%), co-occurring disorders and special populations (~8%), pain/CDC opioid prescribing (~6%), cannabis (~5%), tobacco (~5%), sedatives (~5%), harm reduction (~5%), hallucinogens/inhalants (~5%), ASAM levels of care (~4%), neurobiology (~5%), recovery/ethics/law (~3%), and behavioral addictions (~3%). Initial certification fee is ~$1,900; 12-month ACGME Addiction Medicine fellowship required (practice pathway closed after 2025).

Sample ABPM Addiction Medicine Practice Questions

Try these sample questions to test your ABPM Addiction Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Per DSM-5-TR, how many of the 11 criteria (within a 12-month period) define a MODERATE substance use disorder?

A.2-3 criteria

B.4-5 criteria

C.6 or more criteria

D.1 criterion

Explanation: DSM-5-TR SUD severity: mild = 2-3 criteria, moderate = 4-5 criteria, severe = 6 or more. The 11 criteria span impaired control (4), social impairment (3), risky use (2), and pharmacologic criteria (tolerance, withdrawal). Tolerance/withdrawal do NOT count for patients on prescribed medications as directed.

2On the AUDIT-C, what score thresholds identify unhealthy alcohol use in MEN and WOMEN respectively?

A.≥10 for men, ≥7 for women

B.≥8 for men, ≥5 for women

C.≥2 for men, ≥1 for women

D.≥4 for men, ≥3 for women

Explanation: AUDIT-C (3 items scored 0-4 each; range 0-12) flags unhealthy alcohol use at ≥4 for men and ≥3 for women and pregnant people. The full 10-item AUDIT uses ≥8 for men (and some argue ≥4 for women) to indicate hazardous drinking or likely AUD.

3The USPSTF 2020 recommendation for screening for unhealthy drug use in adults (≥18 years) is what grade, and what is the key qualifier?

A.Grade I — insufficient evidence

B.Grade A universal screening with no qualifier

C.Grade D — recommends against screening

D.Grade B when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred

Explanation: USPSTF 2020 gives a Grade B recommendation for screening adults for unhealthy drug use, but ONLY when services are available to accurately diagnose, effectively treat, and provide appropriate care or referral. This is distinct from the Grade B alcohol screening recommendation (2018) using tools like AUDIT-C and SBI.

4Which screening tool is specifically validated for ADOLESCENTS and includes questions about using substances in a Car, to Relax, Alone, Forget, Family/Friends, and Trouble?

A.DAST-10

B.CAGE-AID

C.CRAFFT

D.TAPS

Explanation: CRAFFT is a validated screening tool for adolescents (ages 12-21). The acronym: Car, Relax, Alone, Forget, Family/Friends, Trouble. ≥2 positive answers warrants further assessment. CAGE/CAGE-AID is for adults; DAST-10 screens drug use in adults; TAPS is a 2-stage adult tool (NIDA).

5Which of the 11 DSM-5-TR SUD criteria is NOT counted for a patient appropriately prescribed and taking an opioid analgesic for chronic pain under medical supervision?

A.Use in physically hazardous situations

B.Craving

C.Continued use despite social problems

D.Tolerance and withdrawal

Explanation: DSM-5-TR explicitly states that tolerance and withdrawal DO NOT count toward the SUD diagnosis for individuals taking medications under appropriate medical supervision as directed. This prevents misdiagnosing patients with physiologic dependence as having an OUD.

6Which biomarker of alcohol use has the LONGEST detection window and is most sensitive for detecting moderate-to-heavy drinking over the prior ~3-4 weeks?

A.Carbohydrate-deficient transferrin (CDT)

B.Ethyl glucuronide (EtG) urine

C.Phosphatidylethanol (PEth)

D.Gamma-glutamyl transferase (GGT)

Explanation: PEth (whole blood) is formed only in the presence of ethanol and detects drinking for up to ~3-4 weeks. EtG urine detects drinking over the prior 24-80 hours. CDT reflects heavy drinking over 2-3 weeks but is less sensitive. GGT is nonspecific.

7Which is an example of STIGMA-REDUCING language recommended by SAMHSA, NIDA, and ASAM when documenting care for a patient with opioid use disorder?

A.Drug habit

B.Opioid addict

C.Substance abuser

D.Person with opioid use disorder

Explanation: Person-first, non-stigmatizing language ('person with opioid use disorder') reduces bias and improves patient engagement. Terms like 'addict,' 'abuser,' 'clean/dirty urine,' and 'habit' are discouraged. Use 'substance use,' 'positive/negative toxicology,' and 'return to use' (not 'relapse' pejoratively).

8In the SBIRT framework, what is the approximate recommended duration and structure of the 'brief intervention' component?

A.5-15 minutes, using motivational interviewing and personalized feedback

B.60+ minutes of structured CBT

C.Immediate inpatient admission regardless of severity

D.Weekly 90-minute sessions for 12 weeks

Explanation: SBIRT (Screening, Brief Intervention, Referral to Treatment) uses a brief intervention of ~5-15 minutes (sometimes longer) with motivational interviewing, personalized feedback (FRAMES), and goal-setting. It is most effective for risky use (not severe SUD, which requires referral to treatment).

9A patient scores 4 on the TAPS-1 tobacco item but 0 on all other substances. According to TAPS-2, what is the next step?

A.Administer TAPS-2 sub-items for tobacco only to assess severity

B.Diagnose severe SUD for all substances

C.No further assessment needed

D.Order a urine drug screen only

Explanation: TAPS is a 2-stage tool. TAPS-1 is a 4-item screen; a positive response to any item triggers TAPS-2, which asks substance-specific questions to identify problem use or SUD. You administer TAPS-2 only for the substances endorsed in TAPS-1.

10The USPSTF 2018 recommendation on alcohol screening in primary care is best described as:

A.Grade D — recommends against alcohol screening

B.Grade I — insufficient evidence for any screening

C.Grade B — screen adults ≥18, including pregnant women, using validated tools and provide brief behavioral counseling for risky/hazardous drinking

D.Grade A for men only, I for women

Explanation: USPSTF 2018 recommends (Grade B) that clinicians screen all adults ≥18 years, including pregnant women, for unhealthy alcohol use and provide brief behavioral counseling interventions to adults engaged in risky or hazardous drinking. Grade C for adolescents (insufficient evidence for routine use, selective screening).

About the ABPM Addiction Medicine Exam

The ABPM Addiction Medicine Subspecialty Certification Examination validates expert knowledge in the prevention, screening, diagnosis, and treatment of substance use disorders and related conditions. Scope includes DSM-5-TR SUD diagnosis, SBIRT and validated screens (AUDIT-C, DAST-10, TAPS, CAGE, CRAFFT), neurobiology of addiction, alcohol withdrawal management (CIWA-Ar, benzodiazepines, thiamine), FDA-approved pharmacotherapy for alcohol (naltrexone, acamprosate, disulfiram) and opioid use disorder (methadone, buprenorphine, XR-naltrexone), tobacco cessation (NRT, varenicline, bupropion, cytisinicline), stimulant/cannabis/sedative/hallucinogen/inhalant use disorders, co-occurring psychiatric disorders, behavioral addictions (gambling, IGD), pain management and the CDC 2022 Opioid Prescribing Guideline, harm reduction (naloxone OEND, SSP, fentanyl/xylazine test strips), ASAM Criteria levels of care, and ethics/law (42 CFR Part 2, Ryan Haight Act, MHPAEA, MAT Act 2022 X-waiver elimination). Requires ABMS primary board certification plus a 12-month ACGME-accredited Addiction Medicine fellowship.

Questions

200 scored questions

Time Limit

1-day CBT (~8 hours including breaks)

Passing Score

Criterion-referenced scaled score set by ABPM (modified Angoff)

Exam Fee

~$1,900 initial certification fee (ABPM 2026 subspecialty) (American Board of Preventive Medicine (ABPM) / Pearson VUE)

ABPM Addiction Medicine Exam Content Outline

~18%

Opioid Use Disorder & MOUD

DSM-5-TR OUD; intoxication (miosis, respiratory depression) — naloxone titrated; COWS withdrawal (NOT life-threatening); methadone (full μ, QTc >450, CYP3A4, OTP dispensing); buprenorphine (partial μ, ceiling; X-WAIVER ELIMINATED MAT Act Dec 2022; standard induction at COWS ≥8-12 or micro-induction/Bernese; Sublocade/Brixadi); XR-naltrexone (7-14 day opioid-free); precipitated withdrawal; ACOG/ASAM pregnancy MOUD over withdrawal; NAS (Finnegan, Eat-Sleep-Console); xylazine.

~15%

Alcohol Use Disorder

AUDIT-C (≥4 men, ≥3 women); withdrawal timeline (tremulousness 6-8h, seizures 6-48h, hallucinosis 12-24h, DTs 48-96h); CIWA-Ar ≥8 triggers Rx; symptom-triggered vs fixed-schedule BZD; lorazepam in liver disease; phenobarbital; thiamine 100-500 mg IV BEFORE glucose (Wernicke's prophylaxis); FDA-approved MAUD (naltrexone 50 mg PO/380 mg IM; acamprosate 666 mg TID renal-dose; disulfiram); off-label topiramate/gabapentin; Maddrey DF ≥32 prednisolone; FASD.

~10%

Screening, Diagnosis & Assessment

USPSTF 2020 unhealthy drug use and 2018 unhealthy alcohol use screening; SBIRT (screening, brief intervention, referral to treatment); validated tools (AUDIT/AUDIT-C, DAST-10, TAPS-1/TAPS-2, CAGE, CRAFFT adolescents, NIDA Quick Screen); DSM-5-TR 11 SUD criteria with severity (mild 2-3, moderate 4-5, severe 6+); biomarkers (PEth, EtG/EtS, CDT, GGT); stigma-reducing language.

~8%

Stimulant Use Disorder

Cocaine/methamphetamine intoxication (mydriasis, tachycardia, HTN, hyperthermia, seizures, psychosis — benzodiazepines first-line); cocaine chest pain AVOID beta-blockers (unopposed alpha); benzos/nitrates/CCBs; withdrawal (dysphoria, hypersomnia, hyperphagia — supportive); NO FDA-approved meds — ADAPT-2 bupropion+naltrexone, topiramate, mirtazapine; contingency management strongest evidence.

~8%

Co-Occurring Disorders & Special Populations

Integrated (not sequential) treatment; depression, anxiety, PTSD, bipolar, schizophrenia + SUD; ADHD+SUD (long-acting stimulants/atomoxetine); trauma-informed care; adolescents (CRAFFT, confidentiality); older adults (polypharmacy, falls); pregnancy (MOUD, NAS); racial disparities in MOUD access.

~6%

Pain Management & Opioid Prescribing

CDC 2022 Clinical Practice Guideline — NOT hard caps, individualized; avoid initial doses >50 MME/day; taper slowly ~10%/month as shared decision; EXCLUSIONS for cancer/palliative/end-of-life/sickle cell; PDMP; UDT with confirmatory testing; naloxone co-Rx at ≥50 MME or concurrent BZD; avoid opioid+BZD co-Rx; buprenorphine for chronic pain (Belbuca, Butrans).

~5%

Cannabis Use Disorder

CB1/CB2 receptors; THC vs CBD; DSM-5-TR CUD; withdrawal (irritability, anxiety, insomnia, decreased appetite 1-3 wk); cannabinoid hyperemesis syndrome (cyclic vomiting, pathognomonic hot-shower relief — capsaicin, haloperidol, cessation); synthetic cannabinoids K2/Spice; psychosis risk in early heavy use; developmental effects.

~5%

Tobacco & Nicotine

Fagerström; NRT patch+short-acting combo superior; varenicline α4β2 partial agonist (start 1-2 wk before quit; black-box removed 2016 post-EAGLES); bupropion SR (contraindicated seizures/bulimia/alcohol withdrawal); cytisinicline (2024 new); EVALI vitamin E acetate; menthol.

~5%

Sedative/Hypnotic & BZD

BZD withdrawal POTENTIALLY FATAL (seizures, DTs-like); long-acting cross-taper (diazepam, chlordiazepoxide); flumazenil contraindicated in chronic BZD (precipitates seizures) and mixed TCA OD; Z-drugs (zolpidem); barbiturate taper with phenobarbital; GHB/GBL severe withdrawal; carisoprodol.

~5%

Hallucinogens, Dissociatives & Inhalants

Classic hallucinogens (LSD, psilocybin, DMT) 5-HT2A agonism, no withdrawal; HPPD; dissociatives (ketamine, PCP, DXM); MDMA (2024 FDA CRL); serotonin syndrome (clonus, hyperreflexia, hyperthermia); inhalants — sudden sniffing death from catecholamine-sensitized arrhythmia; nitrous oxide B12 deficiency/myeloneuropathy.

~5%

Harm Reduction

SSP (reduce HIV/HCV, gateway to Rx); OEND (IN 4 mg Narcan, 8 mg Kloxxado, IM); fentanyl + xylazine test strips; Overdose Prevention Centers (NYC 2021, RI 2024); Good Samaritan laws; xylazine wound care; methamphetamine harm reduction.

~5%

Neurobiology of Addiction

Koob/Volkow three-stage model (binge/intoxication, withdrawal/negative affect, preoccupation/anticipation); mesolimbic dopamine VTA→NAc; PFC executive dyscontrol; extended amygdala CRF stress anti-reward; cue reactivity; heritability ~50%.

~4%

ASAM Criteria & Levels of Care

ASAM Six Dimensions (1 intoxication/withdrawal, 2 biomedical, 3 emotional/cognitive, 4 readiness, 5 relapse, 6 recovery environment); Levels 0.5 (early intervention), 1 (OP), 2.1 IOP, 2.5 PHP, 3.1/3.5/3.7 residential, 4 medically managed inpatient.

~3%

Recovery, Ethics & Law

12-step (AA, NA), SMART Recovery, Oxford Houses, peer recovery specialists; 42 CFR Part 2 SUD confidentiality (2024 final rule aligning with HIPAA); Ryan Haight Act and DEA telemedicine evolving rules; MAT Act 2022; ADA protections for SUD; MHPAEA parity; SAP evaluations.

~3%

Behavioral Addictions

Gambling disorder (DSM-5-TR, only behavioral addiction listed); internet gaming disorder (DSM-5-TR Section III; ICD-11 diagnosis); compulsive sexual behavior disorder (ICD-11 impulse-control); treatment — CBT, motivational interviewing, naltrexone evidence in gambling.

How to Pass the ABPM Addiction Medicine Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABPM (modified Angoff)
Exam length: 200 questions
Time limit: 1-day CBT (~8 hours including breaks)
Exam fee: ~$1,900 initial certification fee (ABPM 2026 subspecialty)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABPM Addiction Medicine Study Tips from Top Performers

1Memorize the alcohol withdrawal timeline and match symptoms to time from last drink: tremulousness 6-8 h, withdrawal seizures (generalized tonic-clonic, usually within 6-48 h), alcoholic hallucinosis 12-24 h (visual/tactile, sensorium intact — contrast with DTs), delirium tremens 48-96 h (autonomic hyperactivity, confusion, visual hallucinations, fever). CIWA-Ar ≥8 triggers pharmacotherapy. Symptom-triggered BZD reduces cumulative dose vs fixed schedule. Thiamine 100-500 mg IV must precede or accompany glucose in suspected alcohol use to prevent Wernicke encephalopathy (ophthalmoplegia, ataxia, confusion).

2Know the three FDA-approved MAUDs cold: naltrexone (PO 50 mg daily or XR-IM 380 mg monthly; reduces heavy drinking days; contraindicated with concurrent opioid use and in acute hepatitis/liver failure), acamprosate (666 mg TID; promotes abstinence; renally cleared — avoid CrCl <30; safer in liver disease), disulfiram (250-500 mg daily; aversive — flushing, tachycardia with ethanol; requires high motivation and monitoring; avoid in severe cardiac disease). Off-label: topiramate, gabapentin, baclofen.

3Buprenorphine pearls post–MAT Act 2022: the DATA 2000 X-waiver was ELIMINATED December 29, 2022 — any DEA-registered prescriber (Schedule III) can now prescribe buprenorphine for OUD with no patient caps. Start buprenorphine only once patient is in moderate withdrawal (COWS ≥8-12) after short-acting opioids (~12-24 h) or methadone (~36-72 h) to avoid precipitated withdrawal. Alternative: micro-induction (Bernese method) allows buprenorphine start without discontinuing full agonist. Long-acting injectables: Sublocade (monthly SC), Brixadi (weekly/monthly SC).

4Cocaine-associated chest pain: AVOID beta-blockers as first-line (unopposed alpha-adrenergic vasoconstriction can worsen coronary vasospasm and hypertension). Use benzodiazepines (address sympathetic surge and agitation), nitrates (coronary vasodilation), and calcium channel blockers; aspirin; PCI for STEMI. Later phenytoin/lidocaine if ventricular arrhythmia from sodium-channel blockade. Methamphetamine similar.

5CDC 2022 Clinical Practice Guideline for Prescribing Opioids for Pain key differences from 2016: explicitly NOT intended as hard dose limits or mandatory taper triggers; clinicians should individualize; avoid starting doses >50 MME/day when possible; tapering should be a shared decision, typically ~10%/month (slower in long-term users); EXCLUSIONS — sickle cell disease, active cancer, palliative care, end-of-life care. Co-prescribe naloxone at ≥50 MME/day or with concurrent benzodiazepines. Check PDMP and use urine drug testing with confirmatory (LC-MS/MS) when results are unexpected.

Frequently Asked Questions

What is the ABPM Addiction Medicine subspecialty certification?

The ABPM Addiction Medicine subspecialty certification is awarded by the American Board of Preventive Medicine to physicians who demonstrate expert-level knowledge in the prevention, screening, diagnosis, and treatment of substance use disorders and related addictive conditions. Scope includes alcohol, opioid, stimulant, cannabis, tobacco, sedative, hallucinogen, and inhalant use disorders; withdrawal management (CIWA-Ar, COWS); FDA-approved pharmacotherapy (naltrexone, acamprosate, disulfiram, buprenorphine, methadone, XR-NTX, varenicline, NRT); co-occurring disorders; pain/opioid prescribing (CDC 2022); harm reduction; ASAM Criteria; and ethics/law (42 CFR Part 2, MAT Act 2022). Originally administered by ABAM, the certification transitioned to ABPM in 2016; the ABAM practice pathway has closed and fellowship training is now required.

Who is eligible to take the ABPM Addiction Medicine exam?

Candidates must hold current ABMS primary board certification in good standing (e.g., family medicine, internal medicine, pediatrics, psychiatry, emergency medicine, OB/GYN, preventive medicine, anesthesiology) and have completed a 12-month ACGME-accredited Addiction Medicine fellowship. The legacy ABAM practice pathway closed after 2025. A valid unrestricted medical license is required. Fellowship includes ambulatory and inpatient addiction care, withdrawal management, MOUD/MAUD prescribing, co-occurring care, and scholarly activity.

What is the format of the ABPM Addiction Medicine exam?

The exam is a 1-day computer-based examination administered at Pearson VUE test centers, comprising approximately 200 single-best-answer multiple-choice items over roughly 8 hours including breaks. Questions test application across screening/diagnosis, neurobiology, pharmacotherapy, withdrawal management, co-occurring disorders, harm reduction, pain/opioid prescribing, systems of care (ASAM), ethics/law, and special populations (pregnancy, adolescent, older adult). Stems frequently include clinical vignettes, CIWA/COWS scores, urine toxicology, and guideline-based decisions.

How much does the 2026 ABPM Addiction Medicine exam cost?

The 2026 ABPM Addiction Medicine initial subspecialty certification fee is approximately $1,900 (verify current fee on theabpm.org). Cancellation and refund policies follow the ABPM schedule with decreasing refunds as the exam date approaches. Continuing Certification (MOC) is via the Longitudinal Assessment (LA-ADM) quarterly questions or a 10-year secure exam. Retakes within the qualification window require re-registration and full fee payment.

When is the 2026 exam administered?

ABPM Addiction Medicine is typically offered during a testing window in the fall (e.g., October). Applications generally open in spring with a submission deadline in late spring or early summer. Candidates schedule specific appointments with Pearson VUE after application approval. Exact 2026 dates should be confirmed on the ABPM website.

How is the exam scored?

ABPM uses criterion-referenced scaled scoring with a passing standard set by subject-matter experts via the modified Angoff method. A candidate's pass/fail outcome depends on performance relative to the fixed cut-score, not on comparison to other candidates. Score reports include subdomain performance to guide future learning and remediation. Results are typically released several weeks after the testing window closes.

What are the highest-yield topics for ABPM Addiction Medicine?

Highest-yield: DSM-5-TR 11 SUD criteria and severity, USPSTF screening and SBIRT, CIWA-Ar alcohol withdrawal protocols and thiamine-before-glucose, FDA-approved MAUD (naltrexone, acamprosate, disulfiram), COWS and buprenorphine induction (including post–MAT Act X-waiver elimination), methadone QTc and CYP3A4 interactions, XR-NTX opioid-free interval, precipitated withdrawal recognition, cocaine chest pain avoiding beta-blockers, cannabinoid hyperemesis, varenicline vs bupropion contraindications, BZD withdrawal risk and flumazenil pitfalls, pregnancy MOUD per ACOG/ASAM, NAS treatment, ASAM Criteria dimensions and levels of care, CDC 2022 opioid prescribing guideline (no hard caps), naloxone OEND, 42 CFR Part 2 confidentiality, and Ryan Haight Act telemedicine rules.

How should I study for the exam?

Use a structured 6-12 month plan during/after a 12-month Addiction Medicine fellowship. Map to the ABPM content outline: lead with DSM-5-TR/screening and neurobiology, then AUD and OUD pharmacotherapy (highest weight), then stimulants/cannabis/tobacco/sedatives/hallucinogens, co-occurring disorders and special populations, pain/opioid prescribing, harm reduction, ASAM Criteria, and ethics/law. Anchor to guidelines: ASAM National Practice Guideline for OUD, CDC 2022 Opioid Prescribing Guideline, SAMHSA TIPs (TIP 63 MOUD, TIP 45 detoxification), USPSTF, ACOG, DSM-5-TR. Use the ASAM Review Course and The ASAM Principles of Addiction Medicine textbook. Complete high-volume timed MCQs and 2-3 full-length mock exams.