Guide
Guide | Reference

37  Substance-Related Prototypes

37.1 Summary

  • Prototypes organized by substance class with a consistent structure for communication and documentation.

37.2 Included Prototypes (Guide exemplars)

  • Alcohol Pattern Prototype (exemplar).
  • Opioid Pattern Prototype (exemplar).
  • Full catalog appears in the Clean Reference.

37.3 How to Use This Cluster

  • Start with the Atlas entry for substance use and compulsive reward seeking.
  • Rate the Reward, Habit, and Substance-Related Compulsion domain.
  • Apply a prototype label only when it improves communication or documentation.

37.4 Boundary Markers

  • What it is: persistent, harmful use with impaired control.
  • What it is not: occasional use without harm or loss of control.

37.5 Common Overlap

  • Mood and drive dysregulation.
  • Sleep and arousal dysregulation.

37.6 Alcohol Pattern Prototype (Exemplar)

37.6.1 Summary

  • A pattern of recurrent alcohol use with impaired control, tolerance, or withdrawal and functional harm.

37.6.2 Prototype Features

  • Escalating use or difficulty cutting down.
  • Tolerance or withdrawal symptoms.
  • Use despite consequences.

37.6.3 Threshold Guidance

  • Use when alcohol use is recurrent and impairing.

37.6.4 Expected Domain Profile

  • Reward, Habit, and Substance-Related Compulsion: moderate to high.
  • Mood and Drive Dysregulation: variable.

37.6.5 Time-Course and Trajectory

  • Episodic with relapse cycles or chronic use.

37.6.6 Differential and Red Flags

  • Medical conditions mimicking withdrawal.
  • Co-occurring sedative or stimulant use.

37.6.7 Specifiers

Specifiers: course + contributors + risk, as relevant; see Reference for full.

37.7 Opioid Pattern Prototype (Exemplar)

37.7.1 Summary

  • A pattern of opioid use with impaired control, tolerance, or withdrawal and high medical risk.

37.7.2 Prototype Features

  • Craving and loss of control.
  • Tolerance and withdrawal.
  • Use despite harm or risk.

37.7.3 Threshold Guidance

  • Use when opioid use is persistent and impairing or medically risky.

37.7.4 Expected Domain Profile

  • Reward, Habit, and Substance-Related Compulsion: moderate to high.
  • Somatic Distress and Interoception: variable.

37.7.5 Time-Course and Trajectory

  • Chronic with relapse cycles.

37.7.6 Differential and Red Flags

  • Pain management contexts with iatrogenic risk.
  • Co-occurring sedative use increasing overdose risk.

37.7.7 Specifiers

Specifiers: course + contributors + risk, as relevant; see Reference for full.