Coping Behaviours Inventory (CBI)

Abstract

The Coping Behaviours Inventory (CBI) is a standardized psychometric self-report instrument developed by G. K. Litman, J. Stapleton, A. N. Oppenheim, and M. Peleg (1983) at the Addiction Research Unit of the Institute of Psychiatry in London. Designed specifically for individuals diagnosed with alcohol use disorder, the CBI assesses the frequency and nature of cognitive and behavioral coping strategies deployed to prevent, avoid, or manage the resumption of heavy drinking in high-risk situations. Comprising 36 self-administered items—subdivided conceptually into 14 cognitive strategies and 22 overt behavioral actions—the inventory captures four core empirical factors: Positive Thinking, Negative Thinking, Avoidance, and Seeking Social Support (frequently operationalized alongside distraction and substitute activities). Respondents rate each strategy on a 4-point response scale ranging from 0 (Usually) to 3 (Never), providing clinicians and clinical researchers with an index of both coping repertoire breadth and specific response predilections. Psychometric investigations consistently indicate robust internal consistency across subscales and full scale configurations (Cronbach’s coefficient alphas typically ranging from .78 to .91), stable test-retest reliability across clinical treatment windows, and notable predictive validity regarding post-discharge abstinence and relapse latency. The CBI serves as an essential tool in relapse prevention therapy, cognitive-behavioral treatment planning, and addiction health services research, facilitating empirical evaluation of coping skill acquisition and cognitive restructuring.

Keywords

Coping Behaviours Inventory, CBI, alcohol dependence, relapse prevention, cognitive coping, behavioral coping, addiction recovery, substance use disorder, self-efficacy, psychometrics

Authors

The Coping Behaviours Inventory was authored by a team of clinical psychologists, biostatisticians, and behavioral scientists based at the Institute of Psychiatry and the Addiction Research Unit in London, United Kingdom:

• Gloria K. Litman, Ph.D. – Addiction Research Unit, Institute of Psychiatry, The Maudsley Hospital, London, United Kingdom. Dr. Litman was a pioneer in empirical research on relapse prevention and cognitive-behavioral determinants of maintenance in addiction recovery.
• John Stapleton, M.Sc. – Biostatistician and Senior Lecturer, Addiction Research Unit and Department of Biostatistics, Institute of Psychiatry, King’s College London, London, United Kingdom.
• A. N. Oppenheim, Ph.D. – Reader in Social Psychology, London School of Economics and Political Science (LSE), London, United Kingdom. Renowned methodologist and author of foundational texts on questionnaire design and attitude measurement.
• M. Peleg – Clinical Research Associate, Addiction Research Unit, Institute of Psychiatry, London, United Kingdom.

Purpose

The primary clinical and empirical objective of the Coping Behaviours Inventory (CBI) is to systematically identify, categorize, and quantify the specific cognitive and behavioral strategies that individuals with alcohol dependence utilize to thwart cravings, navigate high-risk relapse contexts, and sustain abstinence or achieve controlled consumption. Originally constructed to address theoretical and clinical shortcomings in addiction treatment evaluations during the late 1970s and early 1980s, the instrument sought to move beyond blunt, unitary outcome metrics—such as simple categorical classifications of “abstinent” versus “relapsed”—by uncovering the specific self-regulatory mechanisms governing patient recovery.

In clinical practice, the CBI fulfills several foundational diagnostic and therapeutic functions. First, it enables clinicians to conduct granular baseline assessments of a patient’s pre-existing coping repertoire prior to commencing psychosocial or pharmacological interventions. By identifying specific cognitive deficits (e.g., an inability to recruit positive future orientations or process the negative consequences of alcohol misuse) and behavioral omissions (e.g., underutilization of social support networks, inability to physically leave high-risk drinking venues), treatment providers can customize cognitive-behavioral therapy (CBT) protocols to the distinct functional deficits of the patient. Second, the CBI functions as a sensitive repeated-measures instrument to evaluate treatment progress. Administered longitudinally across detoxification, inpatient rehabilitation, or outpatient aftercare, changes in CBI response profiles demonstrate whether evidence-based interventions successfully enhance an individual’s coping capacity and repertoire flexibility.

In empirical clinical research, the inventory serves as a validated dependent or mediating variable in addiction treatment trials, particularly within randomized controlled trials (RCTs) evaluating relapse prevention programs, motivational enhancement therapy (MET), mutual-help interventions such as Alcoholics Anonymous (AA), and pharmacotherapies intended to alleviate craving. By providing a multidimensional scale that differentiates deliberate cognitive appraisals from physical behavioral maneuvers, the CBI allows investigators to assess which specific coping typologies predict long-term maintenance of sobriety, time-to-first-lapse, and time-to-relapse following discharge from specialized hospital or community addiction units.

Psychological Construct

The Coping Behaviours Inventory operationalizes the construct of coping mechanisms in addictive behaviors, conceptualized as purposeful, learned cognitive appraisals and intentional behavioral adjustments deployed to withstand internal cravings, conditioned urges, and external environmental triggers associated with alcohol use. Grounded in empirical factor-analytic work conducted by Litman and colleagues, the inventory delineates coping along distinct operational axes:

1. Positive Thinking

This cognitive dimension represents an individual’s conscious mobilization of constructive, optimistic, and self-affirming appraisals regarding their current health, future aspirations, and recovery lifestyle. Rather than dwelling on defeat or denial, the respondent reframes their present reality to emphasize the tangible physical, psychological, and social benefits derived from remaining abstinent. Specific manifestations include:

• Reflecting on personal improvement and life quality without alcohol (Item 1: “Thinking about how much better off I am without drink”; Item 26: “Reminding myself of the good life I can have without drink”).
• Active cognitive reframing and optimism (Item 4: “Thinking positively”; Item 22: “Looking on the bright side and trying to stop making excuses for myself”).
• Affirming personal agency, dignity, and recovery maintenance (Item 32: “Saying I am well and wish to stay so”; Item 13: “Knowing that by not drinking I can show my face again without fear of what others will think”).

2. Negative Thinking

Contrary to maladaptive rumination, this cognitive factor encompasses the deliberate recall and sober evaluation of the destructive, painful, and aversive consequences of past drinking episodes. By holding these severe outcomes in working memory, the individual counteracts euphoric recall and selective memory biases common in addiction. Specific manifestations include:

• Confronting the personal devastation, remorse, and interpersonal chaos induced by previous relapses (Item 5: “Thinking of the mess I’ve got myself into through drinking”; Item 19: “Remembering how I’ve let my friends and family down in the past”).
• Realistic cost-benefit appraisal of the drinking urge (Item 17: “Realizing it’s just not worth it”; Item 23: “Realizing it’s affecting my health”).
• Anticipating interpersonal fallout and familial distress (Item 25: “Considering the effect it will have on my family”; Item 34: “Remembering how it has affected my family”).

3. Avoidance and Distraction

This overt behavioral dimension reflects concrete physical actions executed to separate oneself from alcohol-saturated environments, interrupt acute craving cycles, and substitute drinking behaviors with alternative somatic or domestic activities. It combines stimulus control principles with constructive behavioral substitution:

• Physical stimulus removal and barrier placement (Item 10: “Leaving my money at home”; Item 30: “Avoiding places where I drank”; Item 18: “Waiting it out until everything is shut”).
• Behavioral diversion through physical activity, tasks, or physiological regulation (Item 21: “Going for a walk”; Item 24: “Start doing something in the house”; Item 29: “Eating a good meal”; Item 33: “Going to sleep”).
• Avoidant withdrawal during peak vulnerability (Item 8: “Staying indoors – hiding”).

4. Seeking Social Support and Interpersonal Resource Utilization

This dimension captures the adaptive social coping efforts employed to establish connection, gain therapeutic accountability, and minimize exposure to substance-using networks. Recognizing that isolation heightens vulnerability to relapse, this factor assesses:

• Direct communication with informal support systems (Item 2: “Telephoning a friend”; Item 31: “Thinking about all the people who have helped me”).
• Active curation of social environments to prioritize non-drinking peers (Item 3: “Keeping in the company of non-drinkers”; Item 20: “Keeping away from people who drink”).
• Engagement with structured mutual-help organizations and recovered role models (Item 12: “Going to an A.A. meeting”; Item 27: “Getting in touch with old drinking friends who are better now”).

Theoretical Framework

The development of the Coping Behaviours Inventory is situated at the intersection of two foundational theoretical paradigms: the Transactional Model of Stress and Coping articulated by Richard S. Lazarus and Susan Folkman (1984), and the Cognitive-Behavioral Model of Relapse Prevention formulated by G. Alan Marlatt and Judith R. Gordon (1980, 1985).

Under Lazarus and Folkman’s transactional model, coping is defined as constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person. Within the context of substance dependence, the craving state, withdrawal distress, or exposure to alcohol cues constitutes a primary threat appraisal. The Coping Behaviours Inventory directly measures the secondary appraisal and execution phases: what resources does the patient possess, and what specific problem-focused (e.g., removing alcohol, leaving money at home) or emotion-focused (e.g., positive thinking, confronting negative feelings) strategies are implemented to re-establish homeostatic equilibrium without reverting to chemical use.

Concurrently, Marlatt and Gordon’s relapse taxonomy posits that exposure to a high-risk situation (e.g., negative emotional states, interpersonal conflict, social pressure) acts as the precipitating trigger for a lapse. According to this model, if an individual executes an effective coping response, their sense of perceived self-efficacy increases, drastically decreasing the probability of relapse. Conversely, an individual lacking an adequate coping response experiences reduced self-efficacy, heightened positive outcome expectancies for alcohol consumption, and an initial lapse, which frequently degenerates into full-blown relapse via the Abstinence Violation Effect (AVE). Litman and colleagues (1979, 1983) applied this architecture to demonstrate empirically that it is not simply the occurrence of stress or craving that determines outcome, but the breadth, flexibility, and type of coping behaviors executed during high-risk intervals.

Validity

The psychometric validity of the Coping Behaviours Inventory has been documented across clinical and research samples, establishing construct, convergent, discriminant, and predictive validity:

Construct Validity

Construct validity was established by Litman et al. (1979, 1983) through rigorous item-selection procedures, contrast groups, and factor analyses. Initial item pools derived from hospitalized alcohol-dependent patients’ spontaneous reports of successful avoidance strategies were refined to ensure high substantive relevance. Confirmatory studies comparing active drinkers, relapsed individuals, and long-term abstinent individuals demonstrated that successful maintainers utilize a significantly broader range of distinct coping categories, characterized by higher deployment of active cognitive strategies (both positive and negative thinking) and strategic social support seeking, compared to individuals who rapidly relapse.

Predictive and Criterion-Related Validity

Multiple prospective longitudinal studies demonstrate the predictive utility of the CBI regarding treatment outcome:

• In the original validation cohort of hospitalized alcohol-dependent individuals, Litman et al. (1983) reported that post-treatment coping scores significantly discriminated between “relapsers” and “survivors” (abstinent patients) at 6-month and 12-month follow-up evaluations. Specifically, non-relapsers engaged in a statistically higher frequency of cognitive reframing (Positive Thinking, p < .01) and active external avoidance maneuvers.
• Follow-up survival analyses conducted in addiction services confirmed that patients reporting higher overall coping frequencies on the CBI at treatment discharge demonstrated substantially prolonged latency to the first alcohol lapse and fewer heavy drinking days over 1-year observation periods.

Convergent and Discriminant Validity

The CBI displays robust convergent associations with theoretically related psychological constructs. Significant positive correlations have been established between CBI total and subscale scores and instruments measuring general coping efficacy, such as the Coping Strategies Inventory (CSI) and the Processes of Change Questionnaire in transtheoretical models of change. Furthermore, CBI scores correlate positively with validated self-efficacy metrics, including the Situational Confidence Questionnaire (SCQ-39) and the Alcohol Abstinence Self-Efficacy Scale (AASE), confirming that self-reported coping frequency aligns with situational confidence to avoid drinking.

Discriminant validity is supported by modest to negligible correlations between the CBI and generalized trait anxiety, social desirability measures, and intelligence indices, verifying that the inventory measures distinct state-dependent behavioral and cognitive coping efforts rather than generic social compliance, cognitive ability, or baseline affective distress.

Reliability

The reliability of the Coping Behaviours Inventory has been substantiated across diverse international cohorts, verifying high internal consistency and measurement reproducibility:

Internal Consistency

In the seminal psychometric investigation by Litman et al. (1983), the overall 36-item inventory demonstrated an internal consistency reliability coefficient (Cronbach’s alpha) of .91, indicating exceptional item homogeneity. Subscale reliability estimates have consistently met or exceeded standard psychometric benchmarks across empirical investigations:

• Positive Thinking: Cronbach’s α ranges from .82 to .88.
• Negative Thinking: Cronbach’s α ranges from .79 to .85.
• Avoidance / Distraction: Cronbach’s α ranges from .76 to .83.
• Seeking Social Support: Cronbach’s α ranges from .74 to .82.

Test-Retest Reliability and Stability

Test-retest reliability assessments administered over 2-week to 4-week intervals among stable, non-crisis inpatient cohorts yielded intraclass correlation coefficients (ICCs) and Pearson’s r values ranging from .78 to .86 for the global instrument, demonstrating strong temporal stability when clinical status remains constant. In longitudinal intervention studies, the scale displays expected sensitivity to change, registering statistically significant increases in coping deployment following targeted CBT relapse prevention training, thereby demonstrating that stability does not preclude therapeutic responsiveness.

Factor Analysis

The internal structural validity of the CBI was originally derived through principal components analysis (PCA) with orthogonal (Varimax) and oblique rotations on data collected from treatment-seeking hospitalized alcoholics (Litman et al., 1979, 1983). These exploratory factor analyses identified a replicable four-factor solution accounting for approximately 42% to 48% of the total variance across clinical samples:

• Factor 1: Positive Thinking (Cognitive Reframing). High-loading items (λ = .52 to .74) include Item 1 (“Thinking about how much better off I am without drink”), Item 4 (“Thinking positively”), Item 26 (“Reminding myself of the good life I can have without drink”), and Item 32 (“Saying I am well and wish to stay so”).
• Factor 2: Negative Thinking (Aversive Consequence Recall). Salient loadings (λ = .48 to .71) encompass Item 5 (“Thinking of the mess I’ve got myself into through drinking”), Item 19 (“Remembering how I’ve let my friends and family down in the past”), Item 23 (“Realizing it’s affecting my health”), and Item 34 (“Remembering how it has affected my family”).
• Factor 3: Avoidance and Behavioral Distraction. Prominent loadings (λ = .45 to .68) include Item 10 (“Leaving my money at home”), Item 18 (“Waiting it out until everything is shut”), Item 21 (“Going for a walk”), Item 24 (“Start doing something in the house”), and Item 30 (“Avoiding places where I drank”).
• Factor 4: Seeking Social Support. Defining items (λ = .50 to .75) include Item 2 (“Telephoning a friend”), Item 3 (“Keeping in the company of non-drinkers”), Item 12 (“Going to an A.A. meeting”), and Item 20 (“Keeping away from people who drink”).

Subsequent confirmatory factor analytic (CFA) studies examining diverse translations and adaptations have validated this multidimensional structure. Fit indices for the four-factor correlated model generally exhibit acceptable to good goodness-of-fit parameters: Root Mean Square Error of Approximation (RMSEA) values typically range between .048 and .062; Comparative Fit Index (CFI) values range from .90 to .94; and Tucker-Lewis Index (TLI) values exceed .90, supporting the empirical distinction between positive cognitive restructuring, aversive negative reflection, environmental stimulus control, and social engagement.

Instrument / Measurement Tool

The formal specifications and structural configuration of the Coping Behaviours Inventory are detailed below:

• Instrument Name: Coping Behaviours Inventory (CBI)
• Alternative Titles: Litman’s Coping Behaviours Inventory, Hospitalized Alcoholics Coping Scale
• Developer / Authors: Gloria K. Litman, John Stapleton, A. N. Oppenheim, and M. Peleg (1983)
• Primary Target Population: Adults (18+ years) undergoing evaluation, detoxification, inpatient rehabilitation, or outpatient psychotherapy for alcohol use disorder or alcohol dependence.
• Construct Assessed: Frequency and utilization of cognitive and behavioral coping responses designed to prevent or halt heavy drinking.
• Total Item Count: 36 items (comprising 14 cognitive items and 22 overt behavioral items).
• Response Scale & Format: 4-point Likert-type frequency scale:
  • 0 = Usually
  • 1 = Often
  • 2 = Sometimes
  • 3 = Never
• Scoring and Transformation:
  • In standard psychometric research protocols, items may be retained in their raw form (where lower numerical values represent greater frequency of coping behavior: 0 = Usually, 3 = Never) or reverse-coded (where 0 = Never, 1 = Sometimes, 2 = Often, 3 = Usually) so that elevated scores directly indicate higher coping activity.
  • Subscale Scores: Calculated by summing or averaging the items associated with each identified factor (Positive Thinking, Negative Thinking, Avoidance, Social Support).
  • Total Score: Calculated by summing all items across the instrument (range: 0 to 108). In reverse-coded scoring, higher total scores reflect a broader, more active coping repertoire.
• Administration Time: Approximately 10 to 15 minutes. Self-administered paper-and-pencil or secure computer/digital clinical interface.

Permissions & Fee and Test Year

The Coping Behaviours Inventory was officially published in 1983 in the British Journal of Addiction (now the journal Addiction), following preliminary developmental articles published by the research team in 1977 and 1979. The scale is in the public domain for non-profit academic research and routine clinical practice, subject to proper formal scholarly citation. The instrument has been cataloged and distributed by public health monitoring bodies, including the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Commercial developers, pharmaceutical clinical trials, or digital health platforms incorporating the instrument into proprietary, fee-generating software should review institutional permissions and adhere to relevant copyright fair-use standards associated with the original journal publisher (Society for the Study of Addiction / John Wiley & Sons).

References

• Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.
• Litman, G. K., Eiser, J. R., Rawson, N. S., & Oppenheim, A. N. (1977). Differences in relapse precipitants and coping behaviour between men and women alcoholics. British Journal of Addiction to Alcohol & Other Drugs, 72(3), 247–254. https://doi.org/10.1111/j.1360-0443.1977.tb00680.x
• Litman, G. K., Eiser, J. R., Rawson, N. S., & Oppenheim, A. N. (1979). Towards a typology of relapse: A factor analytic study of precipitants and coping behaviour. British Journal of Addiction to Alcohol & Other Drugs, 74(1), 51–59. https://doi.org/10.1111/j.1360-0443.1979.tb02412.x
• Litman, G. K., Stapleton, J., Oppenheim, A. N., & Peleg, M. (1983). An instrument for measuring coping behaviours in hospitalized alcoholics: Implications for relapse prevention treatment. British Journal of Addiction, 78(3), 269–276. https://doi.org/10.1111/j.1360-0443.1983.tb02511.x
• Litman, G. K., Stapleton, J., Oppenheim, A. N., Peleg, M., & Jackson, P. (1984). The relationship between coping behaviours, their effectiveness and alcoholism relapse and survival. British Journal of Addiction, 79(3), 283–291. https://doi.org/10.1111/j.1360-0443.1984.tb00274.x
• Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press.
• Moos, R. H., Finney, J. W., & Cronkite, R. C. (1990). Alcoholism treatment: Context, process, and outcome. Oxford University Press.
• Monti, P. M., Kadden, R. M., Rohsenow, D. J., Cooney, N. L., & Abrams, D. B. (2002). Treating alcohol dependence: A coping skills training guide (2nd ed.). Guilford Press.

13. Items of the Scale (Questionnaire)