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time so that any temporal sequencing could be identified. The relationships between coping and use could be compared more closely with the relationships between coping and dependence and dependence and use. If changes were found to occur simultaneously over these time spans then even closer scrutiny would be indicated in order to elucidate the relationships between them.
It might be the case that the effect of coping on the decline in dependence is mediated through other factors. More accurate data on the extent and nature of treatment, and on the influence of treatment on the application of coping strategies would be useful in the construction of a chain of variables which may be found to act as mediators between coping and dependence. Specifically the hypothesis might be that treatment influenced coping which influenced use which in turn influenced dependence. In an alternative design, a comparison could be made between change in dependence when treatment specifically targeted coping and when it did not. Treatment seeking itself may be a form of coping which affects use of the substance and reductions in use over time lead to reductions in dependence.
10.5.2 The measurement of dependence
Further support for the suitability of the LDQ for routine use was provided in this study. The speed and ease with which respondents were able to complete the scale coupled with the data generated by it commend its use in clinical settings.
The current thesis has highlighted areas for further development of the LDQ: validation in groups of users of drugs other than alcohol and heroin remains to be done; general population norms need to be established on the basis of larger general population
samples; sensitivity at the lower end of the dependence spectrum might be improved by the inclusion of an additional response choice and a comparative study of responses to this instrument would need to be conducted to answer this question satisfactorily.
10.6 Is dependence important?
It is my view that dependence is important. Twenty years of clinical practice with problems of substance misuse have persuaded me that the reason that people do not simply give up doing the things that cause them harm is something called dependence. There is no question that dependence, like intelligence, is a complex phenomenon. Like intelligence, its nature is elusive. We think we know what it looks like when it manifests itself. We think it accounts for certain sorts of behaviours and we think people would be better off if they could change it. Dependence seems to me to
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