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account for the nature of the balance between reasons for carrying on and reasons for stopping. These reasons have been termed motivation, and motivation to use or to stop using a substance has proved in itself to be difficult to measure. The approach to its measurement has been the subject of the same sorts of difficulties as the measurement of dependence; is it something people think, something they do, something they feel or something that happens to them, something that they get or have? It was my view that examining coping alongside changes in dependence would help to unravel some of these questions. Finally I have found the concept and its measurement to be meaningful to patients. In the same way I have found to be the case in routine clinical practice, administering the LDQ to participants in all the samples in this study provoked a considerable amount of discussion by way of expansion because of the way that the items were perceived to be meaningful. It is my view that dependence as measured by the LDQ, which taps into the behaviours, thoughts and beliefs of the individual, is the essence of the condition which needs to be the target of intervention in the treatment agency, whether the target is directly or indirectly approached.
If dependence is made up of a set of conditioned responses then procedures such as cue exposure and response prevention would be indicated for its extinction. Treatments based upon these approaches have not met with great success, possibly due to the sheer number of cues to which the dependent behaviour has been conditioned and the difficulty providing a programme of treatment capable of dealing with these. It is unlikely that community, laboratory or clinic based treatments would be able consistently and comprehensively to cover the range of situations which cue dependent substance use. The context of contemporary treatment of dependence is normally the social circumstances in which the dependent individual lives and it is in this context that the behaviour needs to be extinguished. For this reason the teaching of coping strategies has become the focus of treatment. It was therefore one of the aims of the thesis to attempt to elucidate the nature of the relationship between coping and dependence in order better to design such treatments, but that relationship remains unclear.
The sheer amount of theorising on the nature of dependence attests to the complexity of the phenomenon. This thesis has made a small contribution to understanding the course of change in dependence and identifying questions for further research.
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