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patients and looked at a dimension of coping style he has referred to as coping orientation; he distinguished affect regulation (e.g. "told myself things would get better", "exercised to reduce the tension") from problem solving (e.g. active attempts to address problems directly, like organising a detoxification programme or taking disulfiram) and found a relationship between these styles, entry to treatment and outcome.
Moos and colleagues have found that the use of coping behaviours is associated with outcome and they have distinguished coping behaviours along approach / avoidance lines rather than cognitive / behavioural lines. This is a different dimension to the one proposed in the present study and one which should be addressed in analysis of the data.
DiClemente and Prochaska demonstrated that subjects in a study of 872 smokers and ex-smokers used different coping strategies at different stages of change (DiClemente and Prochaska 1985). People described as immotives or pre-contemplators, i.e. those not contemplating change, predictably used fewest coping strategies to quit. Contemplators used cognitive coping strategies and few behavioural coping strategies, arguably an equally tautological finding. Of most relevance to the present discussion is the finding that what turned recent quitters into either relapsers or long term quitters was the difference found in the use of both cognitive (self-reevaluation and self-efficacy) and behavioural (helping relationships) coping strategies, or processes in the language used by these authors. Relapsers used more self-reevaluation while long term quitters had higher self-efficacy and used more support from helping relationships.
6.3 Coping and dependence
In the present study an attempt is made to elucidate the nature of decline in dependence by looking at the use of coping behaviours as dependence changes over time. While Litman and her colleagues used a measure of self-attributed physiological dependence on alcohol in early studies (Litman et al. 1979), the reported analysis compared this with relapse or survival and not with the nature of the coping behaviours used. Furthermore, the understanding of dependence as a physiological phenomenon used by Litman and her colleagues is not used in the present study. It is hypothesised that participants with higher levels of dependence use more behavioural coping strategies in the course of reducing their substance use and / or dependence, and people with lower dependence use more cognitive coping strategies. The basis for this is a similar clinical observation to that made by Shiffman (1984): formal treatment has tended to focus on the teaching of behavioural coping strategies because it is increasingly well established that people do better in an
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