Page 54 - PhD GT

analysed by degree of dependence groups (moderate and severe), significant differences in responses were found for all but seven of the variables. The largest differences were found for those variables thought to be referring to withdrawal states, the priming effect of alcohol and physical symptoms. When the items were subjected to Principal Components Analysis for high dependence and low dependence subjects separately, the main factor to emerge for the high dependence group which accounted for 40.4 per cent of the variance was represented by the withdrawal state items while two main factors accounting for 32.7 and 14.5 per cent of the variance in the moderate dependence group and were made up of withdrawal effects and negative mood states respectively. The authors note that the high dependence group endorsed not only withdrawal states but also alcohol related cues “far more” than the moderately dependent group and while negative mood states were more frequent setting events than withdrawal for the moderately dependent group, the severely dependent group still endorsed them significantly more frequently. Again these authors stress that the findings do not lend weight to the idea that dependence is a physiological state:
“We would maintain that severe withdrawal symptoms are simply a sign of severe dependence, as well as a strong motivation for further drinking” (Rankin et al. 1982 p. 295)
The physiological state associated with severe dependence becomes an important source of motivation for drinking and potent reinforcer of the drinking behaviour.
On the question of the ability of dependence to predict relapse and outcomes other than drinking, a number of studies are relevant. Heather et al. (1983) found that dependence as measured by the SADQ (Stockwell et al. 1979), described as an objective measure of withdrawal and withdrawal relief drinking by the authors, did not predict drinking outcome at six month follow-up whereas a subjective measure of dependence, constructed from an adapted set of questions devised by Schaefer (1971) did show significant correlations with drinking outcomes.
Babor et al. (1987a) examined the ‘rapid reinstatement of the syndrome after a period of abstinence’ element of the drug and alcohol dependence syndrome (Edwards et al. 1982) because on the one hand this marker was suggestive of the possibility that, in its severe form, dependence may be irreversible, (Edwards and Gross 1976) but on the other hand, it may provide the basis for a theory of relapse (Babor et al. 1987a p. 393). Five hypothetical dependence syndrome items (withdrawal, tolerance, salience of alcohol seeking behaviour relative to other important activities, the subjective awareness of a compulsion to drink and the use of alcohol to relieve or avoid
42