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types of manifestations of these learning and biological processes, providing for a somewhat limited concept of the disorder” (Hasin et al. 1988 p. 54)
Hasin et al. (1994) repeated this finding with reference in an investigation of the relationship between the alcohol dependence syndrome and related disabilities in a US general population sample, where she found that :
“one general factor appeared to explain the structure of the data better than two-factor solutions or solutions with more than two factors.” (Hasin et al. 1994 p. 578.)
These authors acknowledge that their results are at odds with other studies using different methodologies. Feingold and Rounsaville (1995) found that the distinction between abuse and dependence was more robust when based in a quantitative model than in a qualitative model and explored the proposal that abuse and dependence are located on a continuum of severity, with abuse being a mild form of dependence. They did, however, conclude that there is a unidimensional construct of drug dependence which is valid within and across different drug groups.
1.5.1 Implications of the bio-psycho-social model
The conceptual and empirical shift from the idea of a discrete entity to a continuum, the questioning of progressive inevitability and the precise nature of the components of the condition opened up new directions in the study of dependence and in the implications for its treatment. Treatment goals other than total abstinence were able to be explored. A landmark study based firmly in this conceptual and empirical shift, focusing on the possibility of a range of treatment goals, was conducted by the Sobells in the late sixties and early seventies (Sobell and Sobell 1973). These researchers, recognising the emerging evidence of the possibility of controlled drinking following a diagnosis of alcoholism, developed and administered an individualised behavioural programme with a controlled drinking goal. In a methodologically rigorous investigation, they followed their treatment and control subjects up over a period of twelve months and twenty-four months (Sobell and Sobell 1976). They reported that subjects who had received individualised behaviour therapy with controlled drinking training were functioning well on twice as many days
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