Page 111 - PhD GT

akin to inability to abstain, whereas others have used it exclusively for within session loss of control, the inability to stop once started. This distinction was perceived by Jellinek (1960) to be so fundamental that it formed the basis of his typology of the disease of alcoholism: as described above, “gamma alcoholics” are those who cannot stop once started, but once they have stopped due to intoxication or illness, it is not loss of control which gets the drinking started again. “Delta alcoholics” are those who are unable to abstain from alcohol but are able to control their consumption once started. Edwards and Gross (1976) proposed that both impaired control and inability to abstain were better seen as components of a “subjective awareness of a compulsion to drink”, a more general marker of alcohol dependence syndrome. Again Heather et al. (1993) included both in the Impaired Control Scale, but found that items referring to each were not distinguished in factor analysis. Kahler et al. (1995) also found that impaired control and inability to abstain items were not distinguished in the factor analysis of a collection of scores derived from several scales measuring the two. They concluded that the results of their study of ninety-seven male alcoholics attending for treatment did not support the distinction between loss of control and inability to abstain given the considerable overlap they found in responses to these items and in the similarities of their correlations with related constructs. The question of whether impaired control is distinct from inability to abstain is revisited in the validation of the Impaired Control Scale for heroin users in the present study. Different patterns of use of different substances which may partially arise out of their psychopharmacology may account for variations for each substance if such variations are identified.
5.5 Is impaired control a component of dependence or just highly correlated with it?
Unable to demonstrate that impaired control and narrowing of drinking repertoire were part of the same dimension as other syndrome markers, (Chick 1980b) questioned the unidimensionality of the alcohol dependence syndrome. Factor analysis of the Edinburgh Alcohol Dependence Schedule revealed that items measuring subjective impaired control loaded on a different factor to the other components of the dependence syndrome, as did the measure of reinstatement after abstinence. Stockwell et al. (1979) initially decided not to include items measuring the altered subjective state in the measurement of the alcohol dependence syndrome on the grounds that:
99