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strategies and this finding was sustained when the possible confound of the inevitably greater numbers was controlled for.
Significance of the number of strategies used found in this study is at odds with the findings reported by Shiffman in 1984. The authors attribute this to a difference in the methodology of the analysis, where using a logistic regression analysis yielded the finding, for example, that doubling the number of responses up to two doubled the probability of an abstinent outcome. The findings of Moser and Annis are, however consistent with those of Litman et al. (1979) who reported that survivors used more coping strategies than relapsers but did not replicate this finding in their 1984 study (Litman et al. 1984), and Bliss et al. (1989) who reported that use of more than one response significantly increased the smoker's chances of remaining abstinent compared with the use of only one response. Bliss et al. also reported the finding that it was the overall number of coping responses used, as opposed to the nature or the combination of those responses, which was predictive of outcome.
Moos and colleagues investigated the relationship between coping strategies and long term outcome of treated patients (Moos et al. 1990). They classified coping strategies into Avoidance and Approach categories and developed a measure of salient aspects of approach coping, such as positive reappraisal, seeking support and problem solving, and salient aspects of avoidance coping such as trying not to think about a problem and venting one's anger about it. The scale they used, the Health and Daily Living Form (HDL) (Moos et al. 1984; Lettieri et al. 1985) was developed for the purpose of measuring coping in a variety of situations but has been applied by the authors to identify coping in patients with alcohol problems. In this scale, patients are asked to consider a stressful event and describe how it was handled in terms of indices of active cognitive, active behavioural and avoidance coping responses. In the development of the scale the authors found a relationship between coping styles, the development of problems and outcome. "...people who rely more on approach coping and less on avoidance coping tend to be more successful in managing life crises and their consequences; these people are less likely to develop substance abuse or psychiatric problems and more likely to remit or recover if they do develop such problems." (Moos 1994 p. 33).
In an eight year follow up study, they found that reliance on active coping skills promotes remission. "Patients who engaged in more active cognitive coping at 2 years post-treatment tended to drink less and be less depressed 8 years later. Patients who relied more on avoidance coping responses 2 years after treatment tended to be more depressed 8 years later" (Finney and Moos 1992 pp. 148-149).
More recently, Moos used the Coping Response Inventory (Moos 1993) with alcohol 129