Page 219 - PhD GT

in understanding drinking behaviour and deciding drinking goals in treatment. They pointed to the controversy over the possibility of achieving a controlled drinking goal as a debate which was insufficiently informed by insights into the importance of degrees of dependence. They devised a simple behavioural measure of dependence (Rankin et al. 1980) and called for the recording of further behavioural manifestations of dependence including those that did not require the consumption of alcohol. The Leeds Dependence Questionnaire (LDQ) is thought to be precisely such a measure, capable of rating severity of dependence in abstinence and detecting change over time. It measures those manifestations of dependence that include thoughts which are beliefs about and attitudes to the use of the substance, and behaviours which characterise the nature of such use.
10.1 The contribution of the thesis to the body of research on dependence
Four hypotheses were stated as null hypotheses at the outset of the study: 1) Dependence, once established, does not diminish over time; as dependence was shown to diminish over time this hypothesis can be rejected. 2) Change in dependence cannot be predicted by pre-treatment demographic characteristics or psychological and social functioning. Significant negative correlations were found between social dissatisfaction and change in dependence at three months and at twelve months; the substance used was the only variable, other than dependence at intake, found to predict change in dependence and the null hypothesis can therefore be rejected. 3) Individuals with high dependence who change (in level of dependence or of use of the substance) use the same coping strategies (cognitive/behavioural) and in the same degree as individuals with low dependence who change. There was evidence that individuals with high dependence who became abstinent used significantly more behavioural coping than those who did not become abstinent, whereas individuals with low dependence who became abstinent used significantly more of all coping strategies than those who did not become abstinent. There was a significant association between behavioural coping and amount of change in level of dependence in those with high dependence, but no such relationship between coping and amount of change in dependence for those with low dependence. This null hypothesis can therefore be rejected. 4) The measurement of impaired control, one component of dependence, has equal predictive validity to the measurement of dependence. While impaired control correlates very highly with dependence, it did not predict change in dependence and it was possibly not the case that dependence at baseline did either. Dependence at baseline did however predict some changes in use which impaired control did not
214