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meanings given to the responses Often and Nearly Always. The latter term appears to have an almost bi-modal distribution of values describing its meaning (see Table 4.4) though it could be argued that this is a mere artefact of the way in which the author has chosen to present the time categories. If every response greater than daily had been condensed into one, the modal response for Often would have been the same as that for Nearly Always. This is a potential problem, though another way of looking at the distribution of responses is suggested by the observation that distribution around the mode is skewed in different directions in each case.
The findings of this study were inconclusive and therefore, since the LDQ had been validated with four response choices, I concluded that it would be prudent to proceed with the study using the LDQ in its validated form. There were insufficient grounds for altering the response choices of the original scale for the purpose of the present study, though the question of the inclusion of ‘Rarely’ merits further investigation.
4.4 Study 2: ability of the LDQ to measure dependence in abstinence
The question of whether dependence endures during a period of abstinence from substance use is addressed in both psychological and physiological approaches to the understanding of the phenomenon. The “rapid reinstatement of previous patterns of use following a period of abstinence” described in the syndrome formulation (Edwards and Gross 1976) is the reported observation which lies at the heart of the belief that dependence is irreversible, a belief held firmly by adherents of a disease approach such as that of members of Alcoholics and Narcotics Anonymous. Expressed as: “the re-institution not just of tolerance and withdrawal but of the holistic clinical dependence syndrome” (Edwards 1990, p. 454), the observation of this phenomenon has been made in community, clinical and laboratory settings. Examining the evidence from both animal and human studies, Edwards (1990) poses the question of whether the phenomenon is the result of disturbances in biological systems or whether as learning theorists have suggested, it is the persistence of responses that have been conditioned to social, physical and psychological cues which remain in the environment. He suggests that the most fruitful line of enquiry may be in a combination of the two approaches: it may be that learned responses endure or that a permanently altered biological state continues to condition them. Whether the dependent behaviour is simply suppressed or extinction of these responses does occur remains unclear. If extinction does occur the likelihood is that it occurs at different rates in different individuals, which, if true, might account for different views about the nature and permanence of this aspect of dependence.
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