100+ Free ABPN Addiction Psychiatry Practice Questions

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Question 1

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Per DSM-5-TR, meeting how many of the 11 criteria within a 12-month period constitutes a SEVERE substance use disorder?

4-5 criteria

2-3 criteria

6 or more criteria

1 criterion

to track

2026 Statistics

Key Facts: ABPN Addiction Psychiatry Exam

~200

Total MCQ Items

ABPN Addiction Psychiatry subspecialty exam

1 day

Exam Length

Computer-based testing at Pearson VUE

$2,200

2026 Exam Fee

ABPN Addiction Psychiatry certification

1 yr

Fellowship Required

ACGME Addiction Psychiatry fellowship after ABPN Psychiatry certification

FDA-Approved MOUDs

Methadone, buprenorphine, naltrexone for opioid use disorder

Pearson VUE

Test Delivery

Computer-based testing at authorized centers

The ABPN Addiction Psychiatry subspecialty certification exam is a 1-day computer-based test administered at Pearson VUE containing approximately 200 single-best-answer MCQs. Content spans SUD assessment and DSM-5-TR, neurobiology, major substance classes (alcohol, opioids, stimulants, cannabis, tobacco, sedatives, hallucinogens, inhalants), medications for addiction treatment, co-occurring psychiatric disorders, behavioral addictions, psychotherapies, ASAM placement, regulatory/ethics (42 CFR Part 2, MAT Act), and special populations. Requires ABPN primary Psychiatry certification plus completion of a 1-year ACGME-accredited Addiction Psychiatry fellowship. 2026 exam fee is approximately $2,200.

Sample ABPN Addiction Psychiatry Practice Questions

Try these sample questions to test your ABPN Addiction Psychiatry 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, meeting how many of the 11 criteria within a 12-month period constitutes a SEVERE substance use disorder?

A.4-5 criteria

B.2-3 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 of the 11 criteria within a 12-month period. The 11 criteria span four domains: impaired control, social impairment, risky use, and pharmacological (tolerance, withdrawal). Craving was added in DSM-5 and retained in DSM-5-TR.

2An inpatient with AUD is admitted with confusion, nystagmus, and ataxia. Before administering dextrose-containing IV fluids, what must be given first?

A.IV folate

B.Thiamine 100 mg IV

C.IV magnesium

D.IV lorazepam

Explanation: Thiamine must be given BEFORE glucose in malnourished or alcohol-dependent patients to prevent precipitating Wernicke encephalopathy. Glucose administered without thiamine can trigger or worsen Wernicke in thiamine-deficient patients because glucose metabolism consumes residual thiamine. Established Wernicke is treated with high-dose thiamine 500 mg IV TID for 2-3 days.

3A patient presents 36 hours after last drink with tremor, tachycardia, anxiety, and a CIWA-Ar score of 18. What is the preferred pharmacologic management?

A.Symptom-triggered benzodiazepine therapy (e.g., lorazepam or diazepam)

B.Haloperidol IM scheduled every 4 hours

C.Oral naltrexone 50 mg daily

D.Observation alone with no medication

Explanation: For moderate-to-severe alcohol withdrawal (CIWA-Ar >10), symptom-triggered benzodiazepine dosing is preferred over fixed scheduling because it reduces total benzodiazepine exposure and duration of treatment while being equally effective. Diazepam and chlordiazepoxide are long-acting; lorazepam or oxazepam are preferred in hepatic dysfunction due to non-oxidative metabolism.

4Which FDA-approved medication for AUD is contraindicated in patients currently taking opioids or requiring acute pain control with opioid analgesics?

A.Acamprosate

B.Naltrexone

C.Disulfiram

D.Topiramate

Explanation: Naltrexone is a mu-opioid receptor antagonist. It precipitates opioid withdrawal in anyone currently using opioids and blocks analgesic response to opioid pain medications. Patients must be opioid-free for at least 7-14 days before oral or IM naltrexone. Acamprosate, disulfiram, and topiramate are not opioid-related.

5Which AUD medication requires patient abstinence at the time of initiation and produces an aversive reaction with alcohol ingestion?

A.Naltrexone

B.Acamprosate

C.Disulfiram

D.Gabapentin

Explanation: Disulfiram inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde when alcohol is consumed, leading to flushing, nausea, vomiting, tachycardia, and headache. Patients must be abstinent (typically 12+ hours since last drink) when disulfiram is started. Motivation and supervised administration improve adherence; it is not a craving-reduction drug.

6A patient with OUD presents with yawning, rhinorrhea, piloerection, myalgias, and pupillary dilation. On the COWS, a total score of 18 corresponds to which severity category?

A.Moderately severe (score 13-24)

B.Mild (5-12)

C.Severe (25-36)

D.Very severe (>36)

Explanation: Clinical Opiate Withdrawal Scale (COWS): 5-12 mild, 13-24 moderate, 25-36 moderately severe, >36 severe. COWS ≥8-13 is commonly required before buprenorphine induction to minimize risk of precipitated withdrawal. Symptoms include mydriasis (not miosis — intoxication causes miosis), piloerection, lacrimation, rhinorrhea, yawning, sweating, tremor, anxiety, restlessness, GI upset, and bone/joint pain.

7An unresponsive patient is found with pinpoint pupils and respiratory rate of 4/min. What is the FIRST-line pharmacologic intervention?

A.Methadone 30 mg PO

B.Flumazenil 0.2 mg IV

C.Haloperidol 5 mg IM

D.Naloxone titrated IM/IV/IN, starting low (e.g., 0.04-0.4 mg) and repeating to restore adequate respirations

Explanation: Naloxone is the reversal agent for opioid overdose. In a hospital setting, titrate to adequate respiration (not full wakefulness) to avoid precipitated withdrawal — typical starting doses are 0.04-0.4 mg IV with repeat dosing every 2-3 minutes. Intranasal naloxone (4 mg) and take-home kits are core harm reduction tools. Duration of naloxone is shorter than many opioids — repeat dosing or continuous infusion may be required, especially with fentanyl.

8Under the MAT Act of 2022 (effective December 29, 2022), which requirement for prescribing buprenorphine for opioid use disorder was ELIMINATED?

A.The requirement that buprenorphine be taken sublingually

B.The need for a DEA registration

C.Schedule III classification of buprenorphine

D.The DATA 2000 X-waiver and associated patient caps

Explanation: The Mainstreaming Addiction Treatment (MAT) Act, enacted in the Consolidated Appropriations Act of 2023 (effective December 29, 2022), eliminated the DATA 2000 X-waiver and associated patient caps. Any clinician with a standard DEA registration including Schedule III authority can now prescribe buprenorphine for OUD. DEA registration renewals after June 2023 include a one-time 8-hour training on treatment of patients with substance use disorders.

9A patient took heroin 4 hours ago. If buprenorphine is administered NOW, what is the most likely consequence?

A.Enhanced euphoria

B.Precipitated opioid withdrawal

C.Immediate respiratory arrest

D.No clinical effect

Explanation: Buprenorphine is a high-affinity partial mu agonist that displaces full agonists still occupying the receptor and replaces them with partial activity, triggering precipitated withdrawal. For short-acting opioids wait 12-24 hours with COWS ≥8-13; for methadone wait 48-72+ hours. Low-dose (Bernese) micro-induction allows concurrent full agonist continuation while titrating small buprenorphine doses.

10A pregnant patient presents with untreated OUD at 20 weeks gestation. What is the recommended treatment approach?

A.Medically supervised withdrawal with naltrexone

B.Taper off opioids using clonidine only

C.Initiate buprenorphine or methadone maintenance (MAT)

D.Observation without pharmacotherapy

Explanation: Per ACOG and SAMHSA, medication for opioid use disorder with methadone or buprenorphine is the standard of care in pregnancy. Medically supervised withdrawal (tapering) is NOT recommended because of high relapse rates and associated overdose risk. Naltrexone is not routinely recommended in pregnancy due to limited safety data. NAS in the neonate is treated with morphine, methadone, or buprenorphine per AAP and assessed via Finnegan or the Eat-Sleep-Console (ESC) model.

About the ABPN Addiction Psychiatry Exam

The ABPN Addiction Psychiatry subspecialty exam certifies psychiatrists who have completed an ACGME-accredited Addiction Psychiatry fellowship. The 1-day computer-based test contains approximately 200 single-best-answer MCQs spanning DSM-5-TR substance use disorder criteria, screening instruments (AUDIT, DAST, CAGE, TAPS, CRAFFT, ASSIST), SBIRT, neurobiology (mesolimbic dopamine, extended amygdala, prefrontal dysfunction), alcohol withdrawal and Wernicke-Korsakoff, opioid use disorder (buprenorphine, methadone, naltrexone, COWS, X-waiver elimination under MAT Act 2022), stimulant and cannabis disorders, tobacco pharmacotherapy (varenicline, bupropion, cytisinicline), benzodiazepine withdrawal, hallucinogens (psilocybin, MDMA, ketamine for TRD), co-occurring psychiatric disorders, behavioral addictions, psychotherapies (MI, CBT, contingency management), ASAM placement, 42 CFR Part 2, CDC 2022 opioid guidance, NAS and perinatal SUD, adolescent and geriatric considerations, and harm reduction.

Questions

200 scored questions

Time Limit

1-day CBT

Passing Score

Criterion-referenced scaled score set by ABPN

Exam Fee

~$2,200 (ABPN 2026) (American Board of Psychiatry and Neurology (ABPN) / Pearson VUE)

ABPN Addiction Psychiatry Exam Content Outline

~15%

Opioid Use Disorder

DSM-5-TR OUD, COWS (miosis, yawning, piloerection, rhinorrhea, myalgia, anxiety), naloxone reversal, methadone (full mu, QTc, CYP3A4, OTP), buprenorphine (partial mu, ceiling; X-waiver eliminated Dec 2022 under MAT Act; standard/home/low-dose micro-induction; Sublocade/Brixadi LA monthly; precipitated withdrawal risk — wait 12-24h short-acting opioid, 48-72h methadone), naltrexone XR (must be 7-14d opioid-free), OUD in pregnancy (bup or methadone per ACOG, NOT tapering; NAS with morphine/methadone/buprenorphine; Finnegan/ESC), harm reduction (naloxone Rx/OTC, SSPs, fentanyl/xylazine test strips, OPCs), xylazine wounds, fentanyl contamination.

~13%

Alcohol Use Disorder

AUDIT/AUDIT-C, DSM-5-TR AUD, CIWA-Ar-guided symptom-triggered benzo therapy (diazepam/lorazepam; phenobarbital alternative), withdrawal timeline (tremor/tachycardia 6-48h → seizures → DTs 2-4d), thiamine 100 mg IV BEFORE glucose for Wernicke prophylaxis, Wernicke-Korsakoff (ophthalmoplegia, ataxia, confusion → amnesia), pharmacotherapy (naltrexone PO/IM — cannot be on opioids; acamprosate TID, renal-dosed, NMDA modulator; disulfiram aversion requires motivated abstinence; topiramate/gabapentin off-label; nalmefene), hepatic and cardiac effects, peripheral neuropathy, FASD, alcohol-induced dementia.

~12%

Co-occurring Disorders

Dual diagnosis prevalence, integrated treatment essential, trauma-informed care. Depression + SUD, anxiety + SUD, PTSD + SUD (concurrent treatment per VA/DoD 2023 guideline; Seeking Safety; PE/CPT compatible), bipolar + SUD (avoid activating antidepressants; lithium, valproate, lamotrigine), schizophrenia + SUD (clozapine uniquely reduces substance use), ADHD + SUD (long-acting stimulants preferred, MMR/Jornay; non-stimulant options — guanfacine XR, atomoxetine), personality disorders, suicidality elevated in SUD with means restriction and safety planning.

~10%

Psychotherapies & Recovery Support

Motivational Interviewing (OARS — open questions, affirmations, reflections, summaries; DARN-CAT change talk; rolling with resistance), CBT for SUD (relapse prevention, functional analysis), Contingency Management (gold standard for stimulants per evidence), Matrix Model (stimulants), 12-step Facilitation (AA/NA linkage), SMART Recovery (CBT/REBT-based alternative), Seeking Safety for PTSD+SUD, family therapy (CRAFT), MET (brief MI), Mindfulness-Based Relapse Prevention (MBRP), recovery capital, certified peer recovery specialists, recovery residences, ASAM criteria dimensions 1-6 and levels 0.5-4 WM.

~8%

SUD Assessment & DSM-5-TR

DSM-5-TR SUD 11 criteria (impaired control, social impairment, risky use, pharmacological — tolerance, withdrawal; craving added in DSM-5); severity mild 2-3, moderate 4-5, severe ≥6. Screening: AUDIT/AUDIT-C (alcohol), DAST-10 (drugs), CAGE, TAPS, CRAFFT (adolescents), WHO ASSIST, USPSTF SBIRT; biomarkers — CDT, GGT, PEth (alcohol); urine drug testing — immunoassay screening vs LC-MS/MS confirmation; stages of change (Prochaska — precontemplation/contemplation/preparation/action/maintenance/relapse).

~8%

Stimulant Use Disorders

Cocaine, amphetamine, methamphetamine: intoxication (mydriasis, tachycardia, HTN, hyperthermia, psychosis — benzos first-line for agitation; avoid beta-blockers acutely with cocaine due to unopposed alpha — use nitrates or CCBs); withdrawal (dysphoria, fatigue, hypersomnolence, hyperphagia — supportive, no FDA-approved medication); off-label pharmacotherapy (topiramate, bupropion, mirtazapine, modafinil); contingency management is gold-standard behavioral treatment; complications — MI, stroke, rhabdomyolysis, excited delirium syndrome, prenatal exposure.

~7%

Tobacco / Nicotine

Fagerstrom Test for Nicotine Dependence, DSM-5-TR Tobacco Use Disorder, 7 FDA-approved first-line medications — NRT (patch, gum, lozenge, inhaler, nasal spray — combination long + short-acting), varenicline (α4β2 partial agonist; start 1-2 weeks pre-quit; 12-24 weeks total), bupropion SR (contraindicated in seizure disorder, eating disorders, active AUD withdrawal), cytisinicline (FDA-approved 2024); e-cigarettes and EVALI (vitamin E acetate), menthol disparities, adolescent vaping, pharmacotherapy in pregnancy (NRT if behavioral fails; varenicline and bupropion data limited).

~6%

Cannabis & Hallucinogens

DSM-5-TR Cannabis UD; cannabis withdrawal (irritability, anxiety, sleep disturbance, decreased appetite; 3-7 days); cannabinoid hyperemesis syndrome (hot showers pathognomonic); synthetic cannabinoids (K2/Spice — severe toxicity, seizures); psychosis risk in adolescent-onset heavy use, schizophrenia association. Hallucinogens: LSD, psilocybin (FDA Breakthrough for MDD/TRD), MDMA (MAPS phase 3 for PTSD; FDA advisory 2024), ketamine/esketamine INTRANASAL for TRD/suicidality (dissociation during infusion), PCP, DMT/ayahuasca. Inhalants: sudden sniffing death from catecholamine-sensitized arrhythmia; nitrous oxide B12 deficiency and myeloneuropathy.

~6%

Neurobiology of Addiction

Mesolimbic dopamine circuit (VTA projections to nucleus accumbens, amygdala, PFC); extended amygdala CRF-mediated stress and negative reinforcement; prefrontal cortex executive dysfunction driving impulsivity and compulsivity; allostasis and opponent-process theory; cue reactivity and incentive salience; Koob's 3-stage cycle (binge/intoxication, withdrawal/negative affect, preoccupation/anticipation); genetics — DRD2 Taq1A, OPRM1 A118G polymorphism modulates naltrexone response; epigenetics; adolescent PFC vulnerability.

~5%

Benzodiazepine & Sedative Use Disorders

DSM-5-TR Sedative/Hypnotic/Anxiolytic UD. Withdrawal potentially fatal — seizures, delirium, autonomic instability. Long-acting taper (diazepam, chlordiazepoxide preferred; avoid long-acting agents in hepatic dysfunction — use lorazepam/oxazepam/temazepam, renally cleared). Phenobarbital taper alternative. Flumazenil contraindicated in chronic BZD users (precipitates seizures). Z-drug dependence similar to BZDs. GHB withdrawal is severe with psychosis, tachycardia, rhabdomyolysis — admit for high-dose benzo/propofol.

~5%

Special Populations & Regulatory

Pregnancy: MAT with bup or methadone preferred over tapering (ACOG); NAS treatment with morphine/methadone/buprenorphine; Finnegan and ESC (Eat, Sleep, Console) assessment. Adolescents: CRAFFT, buprenorphine approved ≥16, contingency management. Geriatrics: Beers avoid benzos/long-acting opioids; DSM-5-TR older-adult AUD; polypharmacy. Regulatory: 42 CFR Part 2 (SUD confidentiality stricter than HIPAA; 2024 HHS final rule harmonization), Ryan Haight Act (telemed controlled substance evolving DEA rules), MAT Act 2022 (eliminated X-waiver), MHPAEA parity, ADA protects individuals in recovery.

~5%

Medical Complications & Pain

IV drug use: right-sided (tricuspid) endocarditis — S. aureus, Bartonella, MRSA; HIV, HCV, HBV; skin and soft tissue infections, abscesses, necrotizing fasciitis, osteomyelitis, septic emboli. HCV one-time screening for all adults 18-79 per USPSTF 2020. HIV PrEP/PEP. Xylazine wounds. Pain and addiction: CDC 2022 Opioid Prescribing Guideline (individualized, avoid initiating >50 MME, taper slow 10%/month when indicated; not intended for cancer/palliative/sickle cell disease); buprenorphine for chronic pain (Belbuca, Butrans); PDMP; urine drug testing; naloxone co-prescribing for high-risk patients.

How to Pass the ABPN Addiction Psychiatry Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABPN
Exam length: 200 questions
Time limit: 1-day CBT
Exam fee: ~$2,200 (ABPN 2026)

Keys to Passing

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

ABPN Addiction Psychiatry Study Tips from Top Performers

1Thiamine FIRST, glucose SECOND — in suspected alcohol use disorder or malnourished patients, give thiamine 100 mg IV before any glucose-containing fluids to prevent precipitating Wernicke encephalopathy. Wernicke triad = ophthalmoplegia (lateral rectus palsy most common), ataxia, confusion. Untreated, it progresses to Korsakoff with anterograde amnesia and confabulation. Full dose protocol in established Wernicke is thiamine 500 mg IV TID × 2-3 days.

2Precipitated withdrawal with buprenorphine — buprenorphine is a HIGH-AFFINITY partial mu agonist that will displace full agonists still bound to the receptor, triggering severe withdrawal. For short-acting opioids wait 12-24 hours and ensure COWS ≥8-13 before first dose. For methadone wait 48-72+ hours with COWS verification. Options if precipitated withdrawal occurs: supportive care with additional buprenorphine titration, clonidine, antiemetics, or the Bernese low-dose/micro-dosing induction (overlapping tiny bup doses while continuing full agonist).

3OUD in pregnancy — medication for opioid use disorder with methadone or buprenorphine is the STANDARD OF CARE. Medically supervised withdrawal (tapering) is NOT recommended because of high relapse rates and associated overdose risk. Naltrexone is not routinely recommended in pregnancy. Buprenorphine-naloxone vs buprenorphine monoproduct — both can be used but monoproduct is historically preferred in pregnancy. NAS treatment: morphine, methadone, or buprenorphine per AAP; assess with Finnegan or the newer ESC (Eat, Sleep, Console) model that reduces pharmacotherapy exposure.

4MAT Act 2022 — the X-waiver (DATA 2000) was eliminated December 29, 2022. ANY clinician with a standard DEA registration including Schedule III authority can now prescribe buprenorphine for OUD without a waiver or patient cap. DEA registration renewal after June 2023 includes a one-time 8-hour training on substance use disorders. This change has dramatically expanded access to buprenorphine. Methadone for OUD still requires an Opioid Treatment Program (OTP) SAMHSA certification — not a standard prescription.

542 CFR Part 2 vs HIPAA — SUD treatment records have historically required stricter consent for disclosure than HIPAA. The 2024 HHS final rule harmonized Part 2 more closely with HIPAA: a single consent for treatment/payment/healthcare-operations is now permissible, but specific redisclosure protections, patient-right-to-restrict, and criminal/civil prohibitions on use in legal proceedings without consent remain. Know that SUD records held by Part 2 programs still enjoy enhanced protections beyond HIPAA.

Frequently Asked Questions

What is the ABPN Addiction Psychiatry subspecialty exam?

The ABPN Addiction Psychiatry subspecialty certification exam is a 1-day computer-based test administered by the American Board of Psychiatry and Neurology (ABPN) through Pearson VUE. It certifies psychiatrists with advanced expertise in the evaluation and treatment of substance use disorders and co-occurring psychiatric illness. The exam consists of approximately 200 single-best-answer multiple-choice questions covering DSM-5-TR SUD criteria, neurobiology of addiction, alcohol/opioid/stimulant/cannabis/tobacco/sedative/hallucinogen use disorders, medications for addiction treatment, co-occurring psychiatric disorders, psychotherapies, ASAM placement criteria, regulatory frameworks (42 CFR Part 2, MAT Act), and special populations.

Who is eligible to take the ABPN Addiction Psychiatry exam?

Candidates must hold current ABPN certification in Psychiatry (primary certification) and must have satisfactorily completed a 1-year ACGME-accredited Addiction Psychiatry fellowship. A valid, unrestricted medical license is required at the time of the examination. Applications are submitted through the ABPN Physician Portal within the designated eligibility window.

What is the format of the ABPN Addiction Psychiatry exam?

The exam is a 1-day computer-based test delivered at Pearson VUE centers consisting of approximately 200 single-best-answer MCQs. Questions are clinical vignette-based and frequently include pharmacologic management, withdrawal assessment, co-occurring psychiatric presentations, regulatory scenarios, and special-population considerations. Content distribution follows the ABPN Addiction Psychiatry content outline.

How much does the 2026 ABPN Addiction Psychiatry exam cost?

The 2026 ABPN Addiction Psychiatry subspecialty certification examination fee is approximately $2,200. This fee is separate from primary ABPN Psychiatry certification and MOC fees. Fees for retakes within the eligibility window require full re-registration. Candidates should verify the current fee on the ABPN website as fees are periodically updated.

When is the 2026 exam administered?

The ABPN Addiction Psychiatry subspecialty exam is typically offered once per year during a defined testing window. Applications open months in advance with a firm submission deadline. Candidates schedule their specific Pearson VUE appointment after application approval. Confirm current 2026 dates on the ABPN Exams page.

How is the exam scored?

ABPN uses a criterion-referenced scaled scoring system. Passing status is determined against a fixed content-expert standard rather than a percentile ranking. Candidates receive subdomain performance information to guide future learning and remediation if needed. Results are typically released several weeks after the testing window closes.

What are the highest-yield topics?

Highest-yield topics include: DSM-5-TR SUD criteria and severity; CIWA-Ar alcohol withdrawal management with symptom-triggered benzodiazepines plus thiamine BEFORE glucose for Wernicke prophylaxis; COWS-based opioid withdrawal and the three FDA-approved OUD medications (methadone, buprenorphine, naltrexone) including the MAT Act 2022 elimination of the X-waiver; precipitated withdrawal prevention; bup/methadone preferred over tapering in pregnancy; contingency management as gold-standard behavioral therapy for stimulants; 42 CFR Part 2 and its 2024 HIPAA harmonization; CDC 2022 opioid prescribing guidance; harm reduction (naloxone, SSPs, fentanyl/xylazine test strips); ASAM placement dimensions and levels of care.

How should I study for ABPN Addiction Psychiatry?

Use your Addiction Psychiatry fellowship year as the primary study window. Core resources include the ASAM Principles of Addiction Medicine, the ASAM Criteria (4th edition), the Kleber/Galanter Textbook of Substance Use Disorder Treatment, DSM-5-TR, SAMHSA TIPs (especially TIP 63 on MAT for OUD), CDC 2022 Opioid Prescribing Guideline, the ABPN Addiction Psychiatry content outline, and AAAP resources. Drill high-volume clinical MCQs with timed sets. Emphasize pharmacologic management of withdrawal, three MOUDs, co-occurring psychiatric disorders, regulatory frameworks, and special populations (pregnancy, adolescents, geriatrics). Complete at least 2-3 timed mock exams before test day.