Addiction Medicine

Question 1

Addiction is a disorder characterized by a persistent and intense urge to use a substance or behavior despite what?

Answer 1

Despite potential harm and negative consequences

Question 2

Addiction reflects a dysregulation of what system, leading to impulsive and compulsive urges?

Answer 2

Dysregulation of motivation

Question 3

What term does the DSM-5 use instead of ‘addict’ or ‘addiction’?

Answer 3

Substance Use Disorder (SUD)

Question 4

According to SAMHSA, recovery is best described as what process?

Answer 4

A process of change in which individuals improve health and wellness, live a self-directed life, and strive to reach their full potential

Question 5

In 1784, Dr. Benjamin Rush described alcohol use disorder as what?

Answer 5

A “disease of the will.”

Question 6

In 2023, what percentage of Americans age 12+ reported current use of nicotine, alcohol, or illicit substances?

Answer 6

59%

Question 7

Which substance was most commonly used in 2023: alcohol, tobacco, or cannabis? Among the illicit drugs, which is most commonly used? Why might this observation be unreliable?

Answer 7

Alcohol (47.5%). Cannabis. Cannabis use is not legal in all states

Question 8

What age group had the highest cannabis use in 2023?

Answer 8

18–25 years (36.7%)

Question 9

Approximately what proportion of Americans met criteria for substance use disorder in the prior year?

Answer 9

17.1%

Question 10

Globally, substance use accounted for how many disability-adjusted life years (DALYs) lost in 2017?

Answer 10

42 million

Question 11

What was the number of U.S. overdose deaths in 2023, and how did it change in 2024? What is 2025 looking like relative to 2024? The use of which drug is frequently implicated in overdose deaths?

Answer 11

105,007 in 2023; decreased to 82,138 in 2024. Increased number of deaths in 2025. Opioids

Question 12

How many people in the US drink alcohol? Of those people, how many are ‘binge alcohol users’ (i.e., multiple drinks in one sitting), and among the binge drinkers, how many meet the criteria for heavy alcohol use? In what year did alcohol use increase by 20%?

Answer 12

134 million; 57.9 million; 14.5 million; 2020

Question 13

All drugs of abuse increase release of which neurotransmitter in the nucleus accumbens? Why is this significant?

Answer 13

Dopamine; Dopamine acts as a natural reward that reinforces drug use

Question 14

What are the three stages of Koob’s model of addiction? What do they involve?

Answer 14

(1) Binge & intoxication (rewarding effects reinforce drug seeking behavior), (2) Withdrawal & negative affect (brain adapts to chronic drug use, leading to stress state during abstinence), (3) Preoccupation & anticipation (persistent craving and compulsive drug seeking)

Question 15

In the withdrawal stage, what happens to hedonic tone (i.e., pleasantness of drug use)?

Answer 15

It drops below baseline as the brain adapts, leading to dysphoria; therefore, a person is more likely to feel unsatisfied during abstinence

Question 16

The preoccupation stage is characterized by what three features?

Answer 16

Compromised executive function, high drug cue salience, and new baselines of low reward and high stress

Question 17

Addiction involves reinforcement in two forms — what are they?

Answer 17

Positive reinforcement (pleasure/reward) and negative reinforcement (relief from withdrawal)

Question 18

Genetics account for what percentage of vulnerability to addiction?

Answer 18

40–60%

Question 19

Which gene variant protects against tobacco dependence by causing smoke intolerance?

Answer 19

CYP2A6

Question 20

Name three psychological risk factors for addiction.

Answer 20

Impulsivity/novelty seeking, executive dysfunction (ADHD, TBI), and mood or trauma-related disorders

Question 21

What social factors increase risk?

Answer 21

Parental use, adverse childhood events, poor family boundaries regarding substance use, and peer use

Question 22

Name three protective factors against addiction

Answer 22

Gender (females are less likely to experience addiction), higher self-esteem, close family/community connections that hold you accountable, and greater ability for delayed gratification (i.e., patience)

Question 23

What are the five steps in treating substance use disorders?

Answer 23

Identification (using DSM-V identified traits and/or screening tools), engagement, physiologic treatment/detoxification, relapse prevention, and maintenance.

Question 24

What are the 4 DSM-5 categories of diagnostic criteria for SUD? How many must be exhibited for diagnosis?

Answer 24

Impaired control, social failure, risky use, and physiologic signs (tolerance, withdrawal)

Question 25

What are some common screening tools for SUD?

Answer 25

Laboratory drug tests, interview (to determine family/medical/social history; also includes self-administered screens like SBIRT).

Question 26

What is detoxification? In what settings can detoxification occur, and when is inpatient necessary?

Answer 26

Process by which the body eliminates a substance; outpatient, psychiatric unit, and/or inpatient medical/ICU (if withdrawal poses medical danger).

Question 27

What are examples of relapse prevention programs?

Answer 27

Inpatient/residential (limited beds, may be financially restrictive for some patients – sober living homes can be an alternative), outpatient day treatment, and mutual support groups (e.g., SMART Recovery).

Question 28

What are the main types of psychotherapeutic treatments for SUD?

Answer 28

Cognitive behavioral therapy, contingency management, motivational enhancement therapy, group/individual therapy.

Question 29

What are the types of pharmacological treatment for opioid, alcohol, and nicotine use disorders?

Answer 29

Opioid: methadone and naltrexone; Alcohol: acamprosate and naltrexone; Nicotine: varenicline, bupropion, and replacement therapy (e.g., patch, gum).