Reference
Guide | Reference

44  Reward, Habit, and Substance-Related Compulsion

44.1 Summary

  • A dimensional construct describing compulsive reward seeking, habit formation, and substance-related loss of control.

44.2 Core Construct

  • Persistent use or reward-seeking despite harm and reduced control.

44.3 Subdimensions

  • Craving and cue reactivity.
  • Compulsive use or habit strength.
  • Tolerance and withdrawal patterns.

44.4 Severity Anchors (0-4)

  • 0: No clinically meaningful compulsive use.
  • 1: Mild, intermittent, limited consequences.
  • 2: Moderate, recurring, with clear impairment.
  • 3: Severe, persistent, with significant harm.
  • 4: Extreme, disabling or unsafe.

44.5 Time-Course Patterns

  • Episodic with relapse cycles.
  • Chronic, persistent use.
  • Fluctuating with stress or access.

44.6 Functional Impact

  • Work/school: missed obligations, decreased performance.
  • Relationships: conflict, secrecy, isolation.
  • Self-care: health decline, risk behaviors.

44.7 Developmental Expression

  • Adolescence: risk-taking or peer-influenced use.
  • Adulthood: coping-related or dependence patterns.
  • Late life: medication interactions and misuse.

44.8 Cultural / Context Notes

  • Legal and social context shape reporting.
  • Stigma affects disclosure and engagement.

44.9 Differential and Rule-Outs

  • Primary mood or anxiety driving use.
  • Medical conditions with overlapping symptoms.
  • Medication effects or iatrogenic contributions.

44.10 Measurement Prompts

  • Brief substance use screen.
  • Timeline of use and consequences.

44.11 Treatment-Relevant Correlates (non-prescriptive)

  • High cue reactivity predicts relapse risk.

44.13 Documentation Snippet (1-2 lines)

  • “Reward/habit compulsion with loss of control and withdrawal; Reward/Habit 3; chronic course.”