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Core Content of Addiction Medicine

Core Content represents the areas of knowledge of a specialist in Addiction Medicine.

Core Content, Version 2 was approved by The American Board of Addiction Medicine Foundation March 11, 2010

Adapted from:
ASAM Content of Addiction Medicine (9/13/06), and Core Content of Addiction Medicine (9/9/09)
Principles of Addiction Medicine, Fourth Edition (2009)

Definitions and Basic Science Concepts

1.0 Definitions

1.1 Addiction
1.2 Addiction Medicine
1.3 Unhealthy use
1.4 Dependence
1.5 Withdrawal
1.6 Detoxification
1.7 Substance Related Disorders
1.8 ICD10 Diagnostic Categories

2.0 Basic Science

2.1 Genetics

2.1.1 Heritability of risk for addition
2.1.2 Epigenetic phenomena related to addiction
2.1.3 Genetic predictors of treatment response

2.2 Pharmacokinetic and Pharmacodynamic Principles

2.2.1 Drug Metabolism and Principles of Drug Interactions (including the impact of addictive drug use on the metabolism of common therapeutic medications)
2.2.2 Reinforcement
2.2.3 Tolerance
2.2.4 Cross-tolerance.
2.2.5 Physical dependence
2.2.6 Conditioning
2.2.7 Sensitization
2.2.8 Impact of route of drug administration (oral, sublingual, intravenous, inhalation, intramuscular, etc.)

2.3 Pharmacology

2.3.1 Alcohol
2.3.2 Benzodiazepines, benzodiazepine receptor agonists, barbiturates and other sedative-hypnotics.
2.3.3 Opioids (opium, heroin, prescription opioids)
2.3.4 Cocaine, amphetamine and other stimulants.
2.3.5 Nicotine and tobacco.
2.3.6 Cannabinoids.
2.3.7 Hallucinogens (LSD, mescaline, psilocybin, and other hallucinogens.).
2.3.8 Dissociatives (phencyclidine, ketamine, dextromethorphan and other dissociatives).
2.3.9 Inhalants (nitrous oxide, hydrocarbons, and other inhalants)
2.3.10 Anabolic Steroids
2.3.11 Club Drugs (MDMA, GHB, and other club drugs)

2.4 Neurobiology of Addiction

2.4.1 Animal models of addiction
2.4.2 Neuropharmacology

2.4.2.1 Acetylcholine
2.4.1.2 Norepinephrine
2.4.2.3 Dopamine
2.4.2.4 Serotonin
2.4.2.5 Gamma-aminobutyric acid (GABA)
2.4.2.6 Glutamate and NMDA receptors
2.4.2.7 Other amino acids and peptides
2.4.2.8 Endogenous Opioids
2.4.2.9 Endocannabinoids

2.4.3 Cellular and molecular mechanism in addiction (including neuro-adaptation, epigenetic phenomena, etc.)
2.4.4 Neuro-imaging of addiction and related phenomena (craving, relapse, recovery, etc.)

Epidemiology and Prevention Concepts

3.0 Epidemiological Concepts

3.1 Epidemiologic associations and interpretation
3.2 Biostatistics

4.0 Epidemiological Trends of Substance Use Disorders

4.1 Incidence, Prevalence and Initiation
4.2 Special Populations

4.2.1 Injury/Trauma
4.2.2 The Elderly
4.2.3 Women
4.2.4 Pregnant Women and Newborns
4.2.5 Adolescents and Young Adults
4.2.6 Families with Alcohol and Other Drug Using Members (including children at risk)

4.3 Alcohol and Drug Use in the Workplace

4.3.1 General Trends and Operational Definitions of Use/Dependence in the Workplace
4.3.2 Adverse Effects

4.3.2.1 Absenteeism
4.3.2.2 Injury: Occupational and Non-occupational
4.3.2.3 Implications for Health Care Utilization

4.3.3 Employee Assistance and Prevention Programs
4.3.4 Clinical and Legal Considerations in Drug Testing

4.3.4.1 Workplace Drug Testing
4.3.4.2 Medical Review Officer (MRO) Responsibilities and Authority

4.3.5 Fitness for duty evaluations
4.3.6 Substance Use Disorders in Health Professionals

4.3.6.1 Epidemiology
4.3.6.2 Intervention, Treatment, and Monitoring

5.0 Prevention

5.1 Primary Prevention
5.2 Secondary Prevention
5.3 Tertiary prevention
5.4 Environmental Interventions to Reduce Alcohol, Tobacco and other Drug Use
5.5 Prevention Programs

5.5.1 High Risk Populations
5.4.2 Educational Approaches
5.5.3 Community Organizational Approaches
5.5.4 Public Policy Approaches

5.5.4.1 Regulation of Supply
5.5.4.2 Demand Reduction

Clinical Concepts

6.0 Screening, Assessment and Brief Intervention

6.1 Screening

6.1.1 Laboratory Tests

6.1.1.1 Clinical Drug Testing

6.1.2. Standard Questionnaires

6.1.2.1 Adults
6.1.2.2 Adolescents
6.1.2.3 Pregnant Women

6.2 Assessment
6.3 Brief Intervention

6.3.1 Ambulatory Care Settings

6.3.1.1. Pregnant Outpatients
6.3.1.2. Adolescent Outpatients

6.3.2 Emergency Departments
6.3.3 Hospital Inpatient Settings

7.0 Overview of Addiction Treatment

7.1 History of Addiction Medicine
7.2 Treatment of Alcohol Use Disorders
7.3 Treatment of Drug Use Disorders
7.4 Linking Addiction Treatment with Other Medical and Psychiatric Treatment
7.5 Alternative Therapies for Alcohol and Drug Addiction
7.6 Non-substance Addictions: Gambling, Sex, Food
7.7 Treatment Needs of Children and Adolescents
7.8 Treatment Needs of Seniors
7.9 Quality Management in Addiction Treatment

7.9.1 Outcome Measurement
7.9.2 Satisfaction Measurement
7.9.3 Performance Evaluation

8.0 Management of Inpatient and Outpatient Intoxication and Withdrawal

8.1 General Principles in Management of Intoxication and Withdrawal
8.2 Management of Alcohol Intoxication and Withdrawal
8.3 Management of Sedative-hypnotic Intoxication and Withdrawal
8.4 Management of Opioid Intoxication and Withdrawal
8.5 Management of Other Drug Intoxication and Withdrawal (e.g., cocaine, stimulants, nicotine, phencyclidine, cannabinoids, hallucinogens, dissociatives, inhalants, steroids, club drugs, etc.)
8.6 Pharmacologic and non-pharmacologic intervention for Neonatal Intoxication and
withdrawal for opioids and sedatives
8.7 Management of adverse impact and long term consequences of alcohol on fetus
8.8 Management of Alcohol/Drug Withdrawal Among Those Hospitalized for an Acute Co-morbid Condition (including Critical Care Detoxification)

9.0 Pharmacologic Interventions for Addictions

9.1 Pharmacological Interventions for Opioid Dependence
9.2 Pharmacological Interventions for Alcohol Dependence
9.3 Pharmacological Interventions for Tobacco Dependence
9.4 Pharmacologic Interventions for Other Drug Dependence
9.5 Pharmacologic and Non-pharmacologic Interventions for Neonatal Intoxication and Withdrawal for Opioids and Sedatives
9.6 Pharmacological Interventions for Non Substance Related Addictions

10.0 Behavioral Interventions

10.1 Psychological aspects of alcohol and drug use, intoxication and addiction (including “set and setting,” placebo, and expectation)
10.2 Patient Engagement and Securing Treatment Entry
10.3 Motivating Patients to Change
10.4 Individual Psychotherapy
10.5 Cognitive Behavioral Therapy

10.5.1 Relapse Prevention
10.5.2 Community Reinforcement and Vouchers
10.5.3 Contingency Management
10.5.4 Matrix Model

10.6 Group Therapy
10.7 Self Help Groups

10.7.1 Twelve Step Programs and 12-Step Facilitation Therapies
10.7.2 Other Self Help Programs

10.8 Couples and Family Counseling, Therapies, and Interventions
10.9 Adolescent Relapse Prevention
10.10 Residential Treatment and Therapeutic Communities
10.11 Treatment Retention and Chronic Disease Management
10.12 Comprehensive Case Management (use of integrated medical care and supplemental services for persons with chronic, persistent addiction)
10.13 Translating Research to Practice
10.14 Principles of Integrating Behavioral and Pharmacological Treatment
10.15 ASAM Patient Placement Criteria and Appropriate Use of Levels of Care.

11.0 Co-Occurring and Medical Disorders among Patients with Alcohol and Other Drug Use and
Addiction

11.1 General Medical Evaluation and Management
11.2 General Medical and Surgical Complications

11.2.1 Cardiovascular Consequences
11.2.2 Hepatic Disorders
11.2.3 Other Gastrointestinal Disorders
11.2.4 Renal and Metabolic Disorders
11.2.5 Respiratory Disorders
11.2.6 Neurological Disorders
11.2.7 Infectious Diseases (HIV, TB, Sexually transmitted infections, and Others)
11.2.8 Hematologic Disorders
11.2.9 Sleep Disorders
11.2.10 Acute Traumatic Injuries
11.2.11 Rehabilitation from Traumatic Brain Injuries and Spinal Cord Injuries
11.2.12 Terminal Illness, Palliative Medicine, and End-of-Life Issues
11.2.13 Endocrine and Reproductive Disorders

11.3 Obstetrical Complications and Pregnancy Related Disorders and Complications
11.4 Fetal Drug Exposure, Including Fetal Alcohol Spectrum Disorders

12.0 Co-Occurring Psychiatric Disorders among Patients with Alcohol and Other Drug Use and
Addiction

12.1 Neuropsychological Dysfunction (Problems with attention, memory, learning, executive function)
12.2 Substance Induced Mental Disorders
12.3 Affective Disorders
12.4 Posttraumatic Stress Disorder
12.5 Other Anxiety Disorders
12.6 Psychotic Disorders
12.7 Attention Deficit/Hyperactivity Disorder
12.8 Eating Disorders
12.9 Personality Disorders
12.10 Cognitive and Behavioral Diagnoses Secondary to in- utero Alcohol and Drug Exposure

13.0 Pain and Addiction

13.1 Musculoskeletal and Orthopedic Problems
13.2 Chronic Non-cancer Pain and Addiction
13.3 Psychological Issues in the Management of Pain
13.4 Non-Opioid Treatments in Management of Pain
13.5 Opioid Treatments in Management of Pain
13.6 Legal and Regulatory Considerations in Pain Management

Social-Legal Concepts

14.0 Ethical, Legal and Liability Issues in Addiction Practice

14.1 Ethical Issues in Addiction Practice
14.2 Informed Consent and Confidentiality in Clinical Practice and Clinical Research
14.3 Clinical and Legal Considerations in Prescribing Drugs for Treatment of Addiction
14.4 Clinical and Legal Considerations in the Treatment of Minors

14.4.1 Adolescent School-based Drug Testing

14.5 Drug Courts and the Treatment of Incarcerated Populations
14.6 Licensing and Credentialing Issues for Health Professionals
14.7 Forensic Addiction Medicine: Expert Witness and Civil Commitment
14.8 Competency and the Assessment of Competence
14.9 Environmental tobacco smoke
14.10 Disability and Substance Use
14.11 Americans with Disabilities Act
14.12 Medical Futility and End-stage Addiction

14.12.1 Therapeutic Pessimism/Nihilism and Pseudo-futility

14.13 Addiction Services Administration

Download PDF version of Core Content for Addiction Medicine

ABAM offers a Transitional Maintenance of Certification program for its current diplomates and a public listing of physicians who hold active ABAM certification status. In March, 2016 the American Board of Medical Specialties formally recognized addiction medicine as a multi-specialty subspecialty. Future certification examinations in addiction medicine will be administered by the American Board of Preventive Medicine.