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Leeds Dependence Questionnaire (see Appendix 1) related to this marker increased with increasing levels of dependence.
So, the learning of dependent behaviour can be seen as a continuation of the learning of drug using behaviour. Initially, though not invariably, a social behaviour with social cues and sources of reinforcement, drug use may develop into a routine behaviour which takes priority over other behaviours with its significant pharmacological reinforcement potential and the likely development of tolerance and withdrawal as further sources of reinforcement. The availability of alternative sources of reinforcement and perception of the importance of the other sources of reinforcement determine continuation and development into dependent patterns of use.
The development of dependence, as noted above, has been the subject of study for researchers across the spectrum of theories of dependence. The question of a sequence in the development of symptoms was addressed by Jellinek (1946) as part of his description of the “phases of alcoholism”. Based upon the accounts of a specific sample of problem drinkers, namely members of Alcoholics Anonymous, Jellinek described a hierarchy of symptoms of alcoholism which progressed from the mild to the severe and, like later writers, asserted that the progression was not an inevitable one but where the most severe symptoms emerged they tended to follow a pattern in their progression. He uses the term symptom to refer at once to cognitions, behaviours and their consequences, both physical, psychological and social but his description of the learning process follows the behavioural understanding outlined above.
“The very beginning of the use of alcoholic beverages is always socially motivated in the prospective addictive and nonaddictive alcoholic. In contrast to the average social drinker, however, the prospective alcoholic (together with the occasional symptomatic excessive drinker) soon experiences a rewarding relief in the drinking situation. The relief is strongly marked in his case because either his tensions are much greater than in other members of his social circle, or he has not learned to handle those tensions as others do....Sooner or later he becomes aware of the contingency between relief and drinking.” (Jellinek 1952 p. 676)
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