# AMC MCQ Addiction Questions: 10 Free Practice MCQs

> 10 free AMC MCQ addiction questions with answers and explanations, from a bank of 19 addiction questions. Try them now, no sign up.

Canonical: https://medhub.one/practice/amc-mcq/addiction
Last updated: 2026-10-31

Addiction questions test a non judgemental assessment and the withdrawal emergency. The AMC MCQ expects you to take a substance history, recognise alcohol withdrawal and delirium tremens, and know the first line treatment and thiamine replacement. It also covers opioid substitution, brief intervention, and the pregnant patient who uses substances. The questions expect a treatment plan and a follow-up contact, not just advice to stop.

## Where candidates lose marks

* Missing alcohol withdrawal in a patient admitted for another reason.
* Forgetting thiamine before glucose in a malnourished patient.
* Using an opioid antagonist to reverse dependence instead of managing withdrawal.
* Judging the patient instead of offering evidence based treatment and follow-up.

**Guideline to follow:** The AMC MCQ follows eTG, the National Health and Medical Research Council alcohol guidance and the Australian opioid dependence treatment guidance.

Ten AMC MCQ-style addiction questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 19 addiction questions and many more across every topic.

[Free timed mock exam](https://medhub.one/practice/amc-mcq/mock)

1. 1 / 10  
A 35-year-old woman completes an inpatient opioid withdrawal program after years of injecting heroin. She feels well, is about to be discharged, and is considering returning to her previous social circle.  
Which discharge measure is most appropriate to reduce her risk of a fatal overdose?  
Show answer

**Answer: C.** Offer take-home naloxone and train her and her partner in how to use it.

**Why:** Tolerance falls during withdrawal, so a person who relapses after treatment is at increased risk of overdose, and peer-administered take-home naloxone should be offered to everyone completing opioid withdrawal, with education for them and their carers. Advising a return to a former dose ignores that reduced tolerance. Adding benzodiazepines increases the risk of fatal respiratory depression, and encouraging her to use alone removes the chance of being found and resuscitated.

  * **A.** Tolerance falls after withdrawal, so resuming a former dose greatly increases overdose risk, which is exactly what the guidance warns against.
  * **B.** Adding a sedative increases the risk of respiratory depression, and combining opioids with benzodiazepines is a recognised cause of overdose death.
  * **D.** Using alone removes the chance of being found and resuscitated, which is the opposite of the harm reduction advice given at discharge.  
Sources: NSW Health. Management of Withdrawal from Alcohol and Other Drugs Clinical Guidance.
2. 2 / 10  
A 40-year-old man who has used methamphetamine daily for two years presents with paranoia and hearing voices. He stopped using six weeks ago and the symptoms have persisted unchanged since then, affecting his ability to stay in his flat.  
What is the most appropriate next step in management?  
Show answer

**Answer: C.** Refer him for specialist mental health assessment and treatment.

**Why:** Methamphetamine-associated psychosis can persist well beyond the period of intoxication and withdrawal, and the NSW Health guidance advises referral for specialist mental health assessment and treatment when psychotic symptoms are severe or continue for several weeks. Reassurance alone does not help symptoms that have persisted unchanged for six weeks. Restarting methamphetamine is not a treatment, and long-term diazepam is not indicated for this presentation.

  * **A.** Symptoms that persist unchanged for several weeks are unlikely to remit with abstinence by itself, and specialist assessment is recommended at this point.
  * **B.** There is no place for ongoing stimulant prescribing, and this would perpetuate rather than treat the problem.
  * **D.** Benzodiazepines are not indicated for persistent methamphetamine-related psychosis and carry their own risk of dependence.  
Sources: NSW Health. Management of Withdrawal from Alcohol and Other Drugs Clinical Guidance.
3. 3 / 10  
An 82-year-old woman is admitted with a hip fracture. Her long-standing medications include temazepam 10 mg at night, which she has taken for several years. She is now unable to take oral medication before surgery.  
Which action is most appropriate regarding her benzodiazepine?  
Show answer

**Answer: C.** Continue a benzodiazepine at a comparable dose while she is unwell and defer any reduction.

**Why:** Hospital admission is a poor setting in which to begin elective benzodiazepine withdrawal, and the guidance warns that abruptly stopping benzodiazepines, even at low doses, can precipitate withdrawal in unwell or older people, sometimes with delirium. The safe course is to maintain the pre-admission dose while the acute problem is treated and to plan a supervised taper afterwards. Raising the dose adds sedation risk without benefit, and swapping to an antipsychotic does not prevent withdrawal.

  * **A.** Abruptly stopping a benzodiazepine can precipitate withdrawal, and older people in particular may develop delirium as a result.
  * **B.** There is no indication to increase the dose, and doing so adds to the risk of oversedation and confusion in an older patient.
  * **D.** An antipsychotic does not prevent benzodiazepine withdrawal and adds its own adverse effects without treating the underlying problem.  
Sources: Queensland Health. Queensland Alcohol and Drug Withdrawal Clinical Practice Guidelines.; NSW Health. Management of Withdrawal from Alcohol and Other Drugs Clinical Guidance.
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5. 4 / 10  
A 40-year-old man presents seeking help for chronic alcohol dependence. He has recently completed an inpatient detoxification program and is motivated to maintain abstinence.  
Which of the following medications is a first-line anticraving agent used in Australia to support alcohol abstinence?  
Show answer

**Answer: B.** Acamprosate

**Why:** Acamprosate calcium (campral) and Naltrexone are first-line medications for relapse prevention in alcohol dependence. Acamprosate reduces craving by modulating NMDA glutamate receptors. Naltrexone blocks opioid receptors, reducing the reinforcing positive effects of alcohol. Disulfiram is second-line.

  * **A.** Disulfiram is an alcohol-deterrent (causes severe sickness if alcohol is consumed), not an anticraving agent, and is second-line due to safety/adherence issues.
  * **C.** Chlordiazepoxide is used for acute detoxification, not for long-term maintenance of abstinence, due to dependency risks.
  * **D.** Methadone is for opioid dependence, not alcohol dependence.  
Sources: RACGP Guidelines for Alcohol and Other Drugs; eTG Complete - Alcohol Dependence Maintenance
6. 5 / 10  
A 44-year-old man with alcohol dependence attends his general practice asking for help to stop drinking. He drinks about 12 standard drinks a day, has no history of seizures or delirium, and has no significant medical comorbidity. He is otherwise well and lives with his partner.  
Which ambulatory diazepam regimen is most appropriate for managing his alcohol withdrawal?  
Show answer

**Answer: A.** Diazepam 10 mg six hourly on day 1, 10 mg eight hourly on day 2, 10 mg morning and night on day 3, 5 mg morning and night on day 4, then 5 mg at night on day 5.

**Why:** The NSW Health withdrawal guidance sets out an ambulatory diazepam regimen that begins at 10 mg six hourly and steps down daily, finishing with 5 mg at night on day 5, and notes that milder cases may need half those doses. Diazepam is the treatment of choice because it is long acting and gives smooth cover as alcohol clears. A loading regimen belongs to patients already in withdrawal or with a seizure history, short acting agents such as oxazepam give more severe withdrawal, and an untapered two week course breaches the 5 to 7 day limit advised for benzodiazepine use in withdrawal.

  * **B.** A loading approach of this kind is reserved for patients who present already in withdrawal or who have a history of withdrawal seizures, and it does not suit planned community based care.
  * **C.** Shorter acting benzodiazepines produce earlier and more severe withdrawal and are not the preferred agent, and abrupt cessation after two weeks risks seizures.
  * **D.** An unreduced two week course exceeds the guidance that benzodiazepine use for withdrawal be limited to 5 to 7 days, and it fails to taper the dose as symptoms settle.  
Sources: NSW Health. Management of Withdrawal from Alcohol and Other Drugs Clinical Guidance.
7. 6 / 10  
A 51-year-old woman with chronic heavy alcohol use and poor dietary intake is admitted for alcohol withdrawal. She has no confusion, ataxia or ophthalmoplegia, and her neurological examination is normal.  
Which thiamine regimen is most appropriate to prevent Wernicke's encephalopathy in this patient?  
Show answer

**Answer: C.** Thiamine 300 mg intravenously daily for the first three days, then 300 mg orally each day for several weeks.

**Why:** For people with chronic high level alcohol use and poor nutrition the NSW Health guidance recommends thiamine 300 mg intravenously daily for the first three days, followed by oral thiamine 300 mg daily for several weeks, because absorption is unreliable and body stores are depleted. Oral 100 mg daily applies to an otherwise healthy person with good dietary intake. Prophylaxis is given to everyone undergoing alcohol withdrawal, not only those with neurological signs, and 500 mg intravenously three times a day is held in reserve for symptomatic or suspected Wernicke's encephalopathy.

  * **A.** That schedule is intended for an otherwise healthy person with good dietary intake, which does not match her chronic heavy use and poor nutrition.
  * **B.** Prophylactic thiamine is recommended for all patients undergoing alcohol withdrawal, not only those who already show neurological features.
  * **D.** That higher parenteral regimen is reserved for patients with symptomatic or suspected Wernicke's encephalopathy rather than for prevention.  
Sources: NSW Health. Management of Withdrawal from Alcohol and Other Drugs Clinical Guidance.
8. 7 / 10  
A 31-year-old man who used methadone until yesterday is being started on buprenorphine for opioid withdrawal. He is fully alert, has a normal pulse and blood pressure, and is not yet showing any signs of withdrawal.  
What is the most appropriate action before giving a full dose of buprenorphine?  
Show answer

**Answer: B.** Give a test dose and observe him because he is not in overt withdrawal.

**Why:** Buprenorphine can precipitate withdrawal in an opioid dependent person who has used short-acting opioids in the previous 12 to 24 hours or methadone in the previous 48 hours or longer, because it displaces the full agonist while providing only partial receptor activity. When the patient is not in overt withdrawal the guidance is to give a test dose and observe before larger doses are given. Waiting two weeks is unnecessary, and naltrexone would precipitate withdrawal even more reliably.

  * **A.** Methadone has a long half-life, so buprenorphine can precipitate withdrawal for 48 hours or more after the last dose, making a full dose now risky.
  * **C.** Such a long delay is unnecessary and would leave his withdrawal untreated, because the relevant window is measured in days rather than weeks.
  * **D.** Naltrexone is an antagonist that precipitates withdrawal in an opioid dependent person, so it is not a safer substitute in this situation.  
Sources: NSW Health. Management of Withdrawal from Alcohol and Other Drugs Clinical Guidance.
9. 8 / 10  
A 70-year-old man who has taken a low dose of a long-acting benzodiazepine for many years is admitted with pneumonia. His benzodiazepine is inadvertently omitted from the medication chart. On day 5 he becomes confused and agitated with fluctuating attention and is restless overnight. He is afebrile and his inflammatory markers are improving.  
What is the most likely explanation for his new confusion?  
Show answer

**Answer: D.** Benzodiazepine withdrawal delirium.

**Why:** The Queensland guidelines note that hospitalised older patients can develop delirium from benzodiazepine withdrawal even after low-dose long-term use, and the omission of a regular benzodiazepine is the key clue in this case. He is afebrile with improving inflammatory markers, so uncontrolled infection does not account for confusion appearing on day 5, and there is no history of heavy alcohol use to suggest alcohol withdrawal. Dementia with Lewy bodies can cause fluctuation but does not explain the clear temporal link to the omitted medicine.

  * **A.** He is afebrile with improving inflammatory markers, so uncontrolled chest infection does not explain confusion appearing on day 5.
  * **B.** Nothing in the history suggests heavy alcohol use, and the omitted regular sedative is the more likely cause.
  * **C.** Fluctuating confusion can occur in that condition, but the clear temporal link to an omitted medicine makes withdrawal the better explanation.  
Sources: Queensland Health. Queensland Alcohol and Drug Withdrawal Clinical Practice Guidelines.
10. 9 / 10  
A 33-year-old woman who uses methamphetamine most days wants to stop. She has no suicidal ideation, stable housing and good family support, and she asks whether withdrawal needs to happen in hospital.  
What is the most appropriate advice about her withdrawal setting?  
Show answer

**Answer: B.** Withdrawal can usually be managed in a community or outpatient setting.

**Why:** Withdrawal from psychostimulants is not medically dangerous, and the NSW Health guidance states that most people can complete it in a community, ambulatory or outpatient setting, with treatment delivered through a stepped care approach. Routine admission is therefore not justified by a fear of seizures or because treatment is only available in hospital. There is also no requirement to wait a month before starting withdrawal.

  * **A.** Withdrawal from psychostimulants is not medically dangerous, so routine admission is not justified by a risk of seizures.
  * **C.** A stepped care approach with psychosocial support is provided in the community, so admission is not needed to access treatment.
  * **D.** There is no requirement to delay, and withdrawal can begin now with appropriate community support.  
Sources: NSW Health. Management of Withdrawal from Alcohol and Other Drugs Clinical Guidance.
11. 10 / 10  
A 34-year-old woman who has taken diazepam 10 mg daily for two years wants to stop. She has no history of seizures or other substance use, her mental state is stable, and she has secure housing.  
What is the most appropriate approach to her benzodiazepine withdrawal?  
Show answer

**Answer: B.** Stabilise her dose with a long-acting benzodiazepine such as diazepam and then reduce it gradually.

**Why:** Benzodiazepine withdrawal is best managed by establishing a therapeutic relationship, stabilising the dose with a long-acting benzodiazepine and then reducing gradually. Onset is delayed by two to five days, so abrupt cessation is unsafe and can provoke seizures. Short-acting benzodiazepines cause earlier and more severe withdrawal and should not be used for the taper. An ambulatory approach is preferred unless safety is at risk, such as with a seizure history, very high doses or an unstable social situation, none of which apply to this patient.

  * **A.** Abrupt cessation is unsafe because withdrawal onset is delayed by two to five days and can be severe, so a supervised taper is required instead.
  * **C.** Short-acting agents cause earlier and more severe withdrawal, so the guidance favours a long-acting preparation for the taper.
  * **D.** An ambulatory setting is preferred unless safety is at risk, for example with a seizure history or very high doses, and neither applies here.  
Sources: Queensland Health. Queensland Alcohol and Drug Withdrawal Clinical Practice Guidelines.

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