Development and validation of the compulsive substance use questionnaire: Attending to substance use automaticity, craving, and continued use despite negative consequences

Background: Compulsivity characterizes an important subtype of substance use disorders (SUDs), but there has been variability in how compulsive substance use is defined and measured. The current study was designed to (1) develop a new measure of substance use compulsivity, (2) validate this scale in a community sample of adults who drink alcohol, and (3) evaluate the association between this new measure of compulsivity and substance use severity. We hypothesize that compulsivity will be characterized by automaticity, craving and insensitivity to negative consequences, and greater substance use severity will be associated with higher levels of substance use compulsivity. Methods: A preliminary set of items were generated for the novel Compulsive Substance Use Questionnaire (CSUQ) to reflect three conceptual aspects of substance use compulsivity: automaticity, craving, and disregarding negative consequences. The study recruited a total of 253 adults who drink alcohol, with a range of severity. Participants answered online surveys on compulsivity, frequency of alcohol use, craving, and negative consequences of alcohol use. Results: We obtained a single-factor solution with 22 items that included 3 automaticity items, 10 craving items, and 9 disregarding negative consequences items. The resulting measure had excellent internal consistency (alpha = 0.96). The CSUQ was associated with substance use severity; specifically, greater compulsivity was associated with heavy alcohol use and higher frequency of negative consequences associated with alcohol use. Conclusions: The current study supports the validity of a new measure of substance use compulsivity, composed of items that closely hew to the concept of substance use compulsivity. Future work investigating compulsivity in other substance use populations with varying levels of severity will further our understanding of compulsive substance use and SUD subtypes.