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Chapter 6
Coping and dependence 6.0 Introduction
The concept of coping is central to many addiction treatment approaches (see for example Kadden et al. 1992; American Psychiatric Association, Work Group on Substance Use Disorders 1995; Monti et al. 1995) where it is generally hypothesised that if patients learn to cope in alternative ways with situations which elicit drug taking responses, then the threat of relapse is diminished (Hodgson and Rankin 1982; Marlatt and Gordon 1985). In the cue exposure approach to the treatment of addictive behaviour, response prevention is based upon the application of coping strategies thus targeting and diminishing the dependent behaviour itself (Dawe and Powell 1995; Rohsenow et al.1995). On the basis of such evidence, investigation of the use of coping strategies was thought to be capable of enhancing an attempt to elucidate the nature of change in dependence.
In the first part of this chapter, the literature on coping and substance use is explored and methods of measuring coping in groups of substance users, including the Coping Behaviours Inventory (CBI), one of the main instruments used to test hypotheses in the main study, are described. In the second part of the chapter, adaptation of the CBI 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 CBIdrg. Both form part of Study 3 (adaptation and validation), initially described in Chapter 4 and subsequently with reference to the adaptation of the ICS and validation of the ICSdrg, in Chapter 5.
6.1 Is there a relationship between levels of dependence and types of coping?
One of the methods proposed to examine the question of how dependence changes is to compare changes in dependence scores over time with behavioural and cognitive coping strategies. If it is the case that dependence endures but is suppressed or inhibited during abstinence, it may be possible to detect the use of different strategies in the process of change over time. Is a reduction in dependence associated with different behaviours, different coping styles than when dependence endures? Do people with high dependence use more behavioural coping strategies than those with
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