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Dependence Questionnaire which I conducted in preparation for the main study is then described. The fifth chapter addresses the subject of impaired control, its measurement and its relationship with dependence. The validation study of the Impaired Control Scale as it was adapted to measure impaired control in heroin users in the present study is reported. The sixth chapter addresses the subject of coping behaviours and their measurement, their relationship with substance use and dependence, and the reasons for the inclusion of a measure of coping in the present study. Again, the validation study of the Coping Behaviours Inventory adapted for use with heroin users for the purpose of the present main study is reported.
Chapter 7 sets out the methodology for the main study designed to test the study hypotheses. Chapter 8 reports on the sample characteristics of the entire cohort recruited to the study, compares the characteristics of those seen at follow-up with those not seen and describes the changes that occurred during the follow-up period in those participants who were followed up at each of the data collection points. Chapter 9 contains the main analysis of the findings regarding the nature and course of decline in dependence. Discussion of the methodology and findings is the focus of Chapter 10.
1.1 The background to the focus of the thesis
Much theorising about dependence has focused upon the nature of the dependent state and its development. Few theorists have dealt with its decline and few empirical studies exist that have attempted to chart this decline. The purpose in the present study of pursuing the question of the nature of decline in dependence is one of clinical utility. While it is broadly accepted in the alcohol field that degree of dependence is an important criterion for deciding drinking goal, and this is based primarily in conclusions derived from the treatment outcome literature, there is less understanding of the processes which underlie this empirical finding. Less explicitly applied in the treatment of other substance dependencies, an understanding of the nature of decline in dependence has potential utility in substitute prescribing decisions and relapse prevention. To the extent that treatment is deemed to enhance the natural processes of recovery, it is important to understand what these processes are. It is for this reason that an understanding of the course of decline in dependence in a clinic population is the subject of this study.
It is proposed that elucidation of the nature of change in dependence will further understanding of the requirements for treatments of substance dependence, will be a criterion for making treatment goal choices, will enable predictions of likely success of different goals and will
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