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Chapter 2
The nature of change
2.0 Introduction
In the previous chapter, recent theorising about the nature of dependence and the uses to which different perspectives were put were described. In this chapter, studies exploring the development, maintenance and decline in dependence are described with a view to identifying the factors which may be relevant to the study of the course of decline in dependence. Evidence for the predictive utility of dependence is also discussed.
2.1 The development of dependence
The existence of mild to severe forms of dependence is implicit in the idea of the dependence syndrome. That there can be a development from the mild to the severe over time seems well established and is discussed below. Whether such development is inevitable has constituted one of the central arguments on the nature of dependence, as has the question of whether there can equally be a decline from the severe to the less severe or mild form of the syndrome.
From the tentative claims made by Edwards and Gross (1976) that “Very speculatively, we may suppose that here the abnormality involves both a biological process and aberrant learning..... the learning process is very incompletely understood...” (p. 1061) grew a much greater certainty that dependence is a learned behaviour subject to the same influences as any other learned behaviour. At the societal level this assertion is based upon the observation that the prevalence of alcohol and drug problems, including dependence, is determined substantially by availability and consequent consumption levels in the population and will vary with these (Edwards et al.1995). At the behavioural level researchers have shown the way in which dependent drinking or drug taking is understood as a discriminated operant (Rankin and Hodgson 1976), discriminated because there are certain setting events or cues which have become associated with such behaviour and act as signals for it to occur.
Stockwell (1990) has described this learning process as resulting in an acquired motivational disposition in which he emphasises the way that the events or cues set up the expectation of the
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