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low dependence? Are more cognitive coping strategies used by people with low dependence and is there a sequence moving from the behavioural to the cognitive as dependence diminishes? Posing the question in this way, it appears that dependence is something that people have and coping is something that people do. It may be that the relationship is quite different, that both are things that people do and that people with high dependence use fewer coping strategies of any kind than people with low dependence. In the main analysis, the relationship between dependence and coping will be explored in order to elucidate the nature of change in dependence and the role that coping strategies may play in such change. One of the factors likely to affect the nature of coping strategies used is treatment which, as noted in the discussion below, tends to focus upon the teaching of behavioural coping strategies.
6.2 Coping and relapse
In the addiction literature the role of coping has been examined with reference to the maintenance of behaviour change and relapse, where coping refers to "what an individual does or thinks in a relapse crisis situation so as to handle the risk for renewed substance use" (Moser and Annis 1996). It was described in a model of relapse in a landmark study on the commonalities across the addictive behaviours (Marlatt and Gordon 1985) where situational determinants and the application of coping behaviours were proposed as the factors predicting relapse and continued abstinence. While this model has been criticised for its lack of attention to the role of decision making in relapse and prevention of relapse processes (Saunders and Houghton 1996), the role of coping strategies has continued to be a fruitful focus for examining factors in outcome. The number and type of coping strategies used, the situational determinants of their application, the perception of their effectiveness and their relationship with other important factors in relapse have been examined.
6.2.1 Cognitive and behavioural coping responses and relationships with outcome
Shiffman (1989) distinguished coping responses along a number of dimensions including the cognitive / behavioural dichotomy. Behavioural coping involves overt action and, he claims, is favoured by clinicians for seeming to be more "potent". Cognitive coping may, on the other hand be more critical to maintaining behaviour change. In an earlier study, he compared the use of behavioural and cognitive coping strategies and examined the relationship between these, the situational determinants of relapse and the outcomes of crisis situations, defined as those in which a
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