Page 44 - PhD GT

In an attempt to investigate further the question of a sequence in the development of dependence, Orford and Hawker (1974) examined the onset of symptoms in a sample of halfway house residents and noted the methodological difficulties in gaining a retrospective account of the development of a condition and particularly one which involves sometimes considerable cognitive impairment. These authors noted that their own sample contained a bias not dissimilar to Jellinek’s in that residents in halfway houses are likely to be selectively socially disadvantaged in the spectrum of the problem drinking population. Difficulties with recall may play a significant role in a population likely to be quite damaged such as this. Orford and Hawker included a variety of symptoms that referred to patterns of consumption, resulting illness and immediate consequences of drinking thus making it difficult to draw conclusions on a sequence in the development of alcohol dependence symptoms alone. They concluded that it was not possible to identify a characteristic sequencing of all events relating to alcoholism because so many of these events will be determined by different social circumstances but that there appears to be “a number of more basic and relatively circumscribed processes which are related and require separate study” (p. 287). They proposed the narrowing of the target of investigation to the core dependence syndrome to see whether a more definite process might emerge.
Chick and Duffy (1979) addressed several of the methodological problems of the earlier research by Orford and Hawker (1974) and narrowed the target behaviour of their enquiry down to the sequencing of dependence syndrome symptoms alone “to determine whether there were systematic deviations from randomness in the orderings of items produced by alcoholics and to derive a typical sequence capable of describing those deviations” (p. 313). They did not show that there was a typical sequence followed by the majority of alcoholics, nor did they assert that later symptoms inevitably follow. Rather they established that, if particular symptoms develop then they will develop in a particular sequence. Their definition of dependence retained the items of tolerance and withdrawal, and they showed that these were late onset symptoms. The symptoms of impaired control on single drinking occasions, feeling the need for alcohol and increasing salience appeared early compared to the onset of the experience of withdrawal symptoms.
However, in contrasting their findings with earlier work, these authors make the point that it has been shown that the symptoms specified themselves exist in degrees and therefore recognition of the appearance of any symptom will depend to an extent upon how the symptom is described in the measure which is used to identify and quantify it. Some questions may refer to milder or more severe degrees of the same symptom.
Another way of looking at how the severity of dependence increases is to chart changing 32