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not. The degree of severity of dependence may be one factor in such change; environmental factors and coping strategies (described above as changes in cognitive and behavioural responses to drug taking cues) have been shown to play an important role.
One of the factors associated with maintaining change in dependent behaviours has been shown to be a change in the environment, the most dramatic example being the experience of the returning Vietnam war veterans where rates of relapse into heroin use were shown to be a tiny fraction of the rates established in civilians following treatment for heroin dependence (Robins et
al. 1975). Removal of the environment which presents conditioned cues for drug taking reduces the experience of craving by removing the opportunity for conditioned withdrawal to occur. Conditions of radical environmental change such as experienced by the returning Vietnam war veterans are difficult to contrive in the every day clinical situation and do not normally occur in many people’s lives. The majority of treated alcohol and heroin addicts will increasingly need to effect behavioural changes in those very situations in which they previously consumed drugs and alcohol. Placed in an environment which formerly conditioned a craving response increases the likelihood of a return to a previous pattern of use. However, the likelihood of such a response is mediated by other factors such as availability of the substance as well as the availability of alternative coping responses. Since the alternative to environmental change would appear to be a change in responses to the environment, the role of coping and its relationship to dependence merits investigation. In Chapter 6, the relationship between coping and relapse is explored and the rationale for investigating the relationship between coping and dependence in a follow-up study of seekers of treatment for alcohol and heroin dependence is discussed.
The questions which the present study seeks to investigate in view of the above involve the nature of change in dependent behaviour: does dependence as measured by the Leeds Dependence Questionnaire (Raistrick et al. 1994) diminish over time? Is the course of such diminution different for people with different levels of dependence and are these different levels of dependence associated with different coping styles (cognitive or behavioural coping strategies)? People with high dependence may have less environmental support for change and therefore be using fewer coping strategies than people with low dependence.
2.4 Validity of the dependence construct
In 1986, Edwards reviewed the validity of the dependence construct in order to demonstrate its clinical, epidemiological and heuristic utility (Edwards 1986). While the concept had generated
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