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Chapter 5
Impaired control and dependence 5.0 Introduction
The focus of this thesis is an examination of the nature of change in dependence where dependence is understood as a psychological phenomenon. In addition to the Leeds Dependence Questionnaire (LDQ), a measure of dependence was sought for the purpose of cross validating the findings of the study, should such a requirement emerge. At the point of initial data collection, no scale other than the LDQ was available which fulfilled the criteria for the measurement of dependence in this study (as described in Chapter 3). The Impaired Control Scale (ICS) (see Appendix 3) was chosen because it measures one of the elements of dependence and is based in a psychological understanding of dependence. Background to the concept of impaired control, its relationship with dependence and the Impaired Control Scale are described in the first part of this chapter. In the second part of the chapter, the adaptation of the Impaired Control Scale for use with groups of help seeking heroin users is reported and this is followed by a report of the validation and reliability testing of the adapted version of the scale, the ICSdrg. Both form part of Study 3 (adaptation and validation), initially described in the previous chapter, Chapter 4.
5.1 Origins and definition: is it lost or is it impaired?
Edwards (1992) has argued that the origins of the psychological view of dependence are to be found in the writings of two eighteenth century medical writers, Rush (1785) and Trotter (1804) both of whom described drunkenness as a habit which was learned and could be unlearned, both of whom included ideas of loss of control over intake as an essential component of this habit. Their description of the condition included both the words disease and habit while later writers were to separate the two into distinct categories of severity.
The disease concept was further developed by Jellinek (1952, 1960) who, as a result of a survey of members of Alcoholics Anonymous, described developmental phases in the drinking history of alcoholics (Jellinek 1946). This survey was extended to the administration of some 2,000 questionnaires to male alcoholics, largely members of Alcoholics Anonymous. On the basis of the results of this larger survey, Jellinek distinguished the disease state of alcoholism - that drinking
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