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Chapter 3
The measurement of dependence
3.0 Introduction
In this chapter a number of methods of measuring dependence, based primarily upon self-report are described; in the first section of the chapter, the use of self-report in the measurement of dependence is discussed. Methods for the enhancement of validity and reliability are examined. In the second part of the chapter, scales developed for the measurement of dependence are described and compared. The principle that dependence “may be seen as being distributed along a dimension rather than being a categorical state” (Gossop et al. 1995 p. 608) is now well established and therefore underlies the selection of scales discussed. Scales measuring the categorical state are not described, nor are scales measuring a unitary concept of alcoholism or drug addiction. The scales discussed below measure dependence as it is understood in the disaggregation of dependence and problems or consequences of use. Most, but not all scales designed to measure the dependence syndrome are substance specific due to retention of the neuroadapted state as an element of the syndrome.
3.1 Self-report is the most usual method of measuring substance use
Self-report procedures have become the dominant form of obtaining clinical data on alcohol problems, between 81% and 90% of studies reviewed by Babor et al. (1987b) and, due to greater problems with other procedures, “are likely to remain an essential research method” (Hammersley 1994). This is also the case for drug misuse research (Maisto et al. 1990) and practice (Sobell et al. 1995). As all measures used in the present study are based upon self-report, there follows a review of the literature on the efficacy of this method.
The accuracy of self-report in individuals with alcohol and drug problems both in treatment and not in treatment has been questioned, possibly due in part to the view that a component of the addicted state is to deny the existence or the severity of the problem. Some of the research on the validity of self-report suffers from methodological problems (and these are discussed below) but the sum of the evidence is positive. A consensus amongst researchers is that, rather than ask whether or
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