Coping Questionnaire

1. Abstract

The Coping Questionnaire (CQ), developed by Jim Orford and colleagues within the Alcohol, Drugs, Gambling and Addiction Research Group at the University of Birmingham, is a specialized, 30-item psychometric instrument designed to assess the behavioral, emotional, and cognitive strategies deployed by family members coping with a relative’s substance misuse or addictive behavior. Rooted empirically and conceptually in the Stress-Strain-Coping-Support (SSCS) model of addiction and the family, the CQ captures how close relatives—such as spouses, partners, parents, siblings, and adult children—respond to the pervasive chronic stress associated with living alongside alcohol and other drug problems. The scale evaluates three primary empirically derived dimensions of coping: Engaged Coping (CQ-E; 14 items), which includes assertive, controlling, emotional, and confrontational attempts to change or limit the relative’s addictive behaviors; Tolerant-Inactive Coping (CQ-T; 9 items), characterized by resignation, passivity, self-blame, putting up with the behavior, and enabling or covering up for the relative; and Withdrawal Coping (CQ-W; composite scoring across 8 operationalized items), characterized by establishing emotional boundaries, pursuing independent interests, maintaining personal autonomy, and detaching from the relative’s addictive crises.

Each item is rated on a 4-point Likert-type frequency metric ranging from 0 (“No”) to 3 (“Often”). Across extensive psychometric investigations conducted in varied sociocultural contexts—including the United Kingdom, Mexico, Italy, Australia, and New Zealand—the CQ has consistently demonstrated sound internal consistency, with Cronbach’s alpha coefficients typically ranging from .73 to .87 for Engaged Coping, .65 to .81 for Tolerant Coping, and .60 to .75 for Withdrawal Coping. Construct, convergent, and discriminant validities are supported through significant associations with measures of psychological and physical strain (such as the General Health Questionnaire and Symptom Rating Test), family conflict, and perceived social support. The instrument is a foundational cornerstone for both clinical practice and applied research, particularly within evidence-based interventions for affected family members, notably the 5-Step Intervention. This article presents a definitive psychometric overview of the CQ, detailing its theoretical architecture, measurement model, structural validity, scoring protocols, and complete verbatim items.

2. Keywords

Coping Questionnaire, CQ, Affected Family Members, Addiction, Substance Misuse, Stress-Strain-Coping-Support Model, Engaged Coping, Tolerant Coping, Withdrawal Coping, Psychometrics, 5-Step Intervention, Alcohol Use Disorder

3. Authors

The Coping Questionnaire was developed and validated by a consortium of clinical psychologists and addiction researchers led by Jim Orford, Emeritus Professor of Clinical and Community Psychology at the School of Psychology, University of Birmingham, United Kingdom. Key co-developers and collaborating investigators include:

• Jim Orford, PhD, FBPsS — School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom. Co-founder of the Addiction Family Support and International Network (AFINet).
• Lorna Templeton, MSc — Independent Research Consultant and former Senior Research Fellow, Mental Health R&D Unit, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom.
• Richard Velleman, PhD, FBPsS — Professor Emeritus of Mental Health Research, Department of Psychology, University of Bath, and Co-Director of Sangath, Goa, India.
• Alex Copello, PhD, FBPsS — Professor of Addiction Research, School of Psychology, University of Birmingham, and Consultant Clinical Psychologist, Birmingham and Solihull Mental Health NHS Foundation Trust, United Kingdom.

The questionnaire emerged from the collaborative research program of the Alcohol, Drugs, Gambling and Addiction Research Group at the University of Birmingham, in prolonged partnership with the Mental Health R&D Unit (Avon and Wiltshire Mental Health Partnership NHS Trust and University of Bath), alongside international collaborators such as Guillermina Natera at the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz in Mexico City.

4. Purpose

For decades, psychiatric and psychological paradigms approached the families of individuals with addiction through pathological lenses. Historical formulations frequently labeled spouses and family members as “co-dependents” or “enablers,” imputing underlying personality pathology, neurotic collusion, or unconscious needs to perpetuate the partner’s addiction. In sharp contrast, the Coping Questionnaire was conceived to operationalize an ordinary, non-pathological, stress-and-coping paradigm. The central thesis animating the CQ is that family members living with an individual suffering from an alcohol or substance use disorder are normal people exposed to extreme, ongoing, highly stressful life conditions. Rather than reflecting an entrenched personality defect, the actions taken by family members represent understandable, variable human coping efforts undertaken in the face of persistent threat, disruption, unpredictability, and emotional distress.

The primary clinical and empirical purposes of the Coping Questionnaire are multifaceted:

• Quantifying Behavioral and Cognitive Coping Responses: The CQ provides an objective, standardized metric to map the diverse spectrum of coping strategies relatives employ in response to substance misuse, categorizing behaviors into active confrontation, passive acceptance/toleration, or emotional and physical distancing.
• Assessing Mechanisms of Change in Family-Focused Interventions: The CQ serves as the primary outcome and process evaluation instrument for interventions designed specifically for affected family members, most notably the manualized 5-Step Intervention. It allows clinicians to monitor therapeutic shifts away from unhelpful extremes—such as hyper-engaged emotional conflict or self-sacrificing tolerant-inaction—toward balanced, assertive coping and healthy self-protective withdrawal.
• De-pathologizing Family Members: By identifying specific, malleable coping behaviors, the instrument aids clinicians in validating the relative’s lived experience, framing their past reactions as understandable attempts to cope with overwhelming strain rather than symptoms of “codependency.”
• Cross-Cultural and Cross-Addiction Research: The CQ provides cross-culturally validated dimensions to explore how socio-ecological context, gender, kinship role (e.g., spouse versus parent), and specific addiction types (e.g., alcohol, illicit drugs, pathological gambling) shape family coping mechanisms globally.

In clinical workflows, administering the CQ enables practitioners to formulate individualized care plans. For example, a spouse demonstrating high Tolerant-Inactive coping and elevated psychological strain can be guided toward boundary setting and reducing self-blame, whereas a parent trapped in high-conflict Engaged coping can be supported in disengaging from non-productive arguments, monitoring behaviors, and emotional volatility.

5. Psychological Construct

The overarching psychological construct assessed by the CQ is family coping under conditions of chronic addiction-related stress. Coping, in this framework, refers to the constantly changing cognitive, emotional, and behavioral efforts exerted by a significant other to manage the specific internal and external demands posed by a relative’s substance misuse or compulsive behaviors. Rather than viewing coping as a static personality disposition, the construct is contextual, dynamic, and multidimensional. Through exhaustive qualitative interviews, thematic analyses, and psychometric factor extractions spanning multiple countries, Orford and colleagues distilled family coping into three core dimensions:

Engaged Coping (CQ-E)

Engaged coping encompasses active, direct attempts by the relative to engage with the user about their drinking or drug use. It is characterized by attempts to alter, monitor, control, regulate, or eliminate the addictive behavior, as well as the expression of acute emotional reactions directly toward the misuser. Engaged coping is not homogeneous; it represents a wide functional continuum ranging from assertive, collaborative problem-solving to highly emotional and confrontational control:

• Assertive / Controlling Efforts: Establishing rules, setting limits, refusing financial bailouts, and attempting to monitor or physically restrict access to the substance (e.g., Item 11: “Tried to limit her drinking by making some rule about it…”; Item 28: “Searched for her drink or hidden or disposed of it yourself?”).
• Emotional / Confrontational Responses: Entering into arguments, pleading, monitoring every move, losing temper, and expressing deep emotional distress, accusations, or distress directly to the relative (e.g., Item 6: “Started an argument with her about her drinking?”; Item 16: “Got moody or emotional with her?”; Item 25: “Accused her of not loving you, or of letting you down?”).
• Constructive Communication: Sitting down to talk frankly about what can be done to resolve the situation or address the household finances (e.g., Item 5: “Sat down together with her and talked frankly about what could be done about her drinking?”; Item 26: “Sat down with her to help her sort out the financial situation?”).

Empirical evidence consistently shows that when engaged coping takes the form of emotional confrontation, hyper-vigilant surveillance, and perpetual argument, it is strongly positively correlated with elevated psychological and physical strain in the family member, as well as heightened household tension.

Tolerant-Inactive Coping (CQ-T)

Tolerant-inactive coping reflects an orientation of resignation, accommodation, passivity, and self-sacrifice in the presence of substance misuse. Relatives exhibiting high levels of this construct tend to place the user’s needs above their own, accommodate destructive habits, and absorb the resulting domestic crises without asserting personal boundaries:

• Covering Up and Making Excuses: Concealing the truth from employers, extended family, or neighbors, pretending that everything is normal, and taking personal blame for the user’s destructive actions (e.g., Item 27: “When things have happened as a result of her drinking, made excuses for her, covered up for her, or taken the blame yourself?”; Item 30: “Tried to keep things looking normal, pretended all was well when it wasn’t or hidden the extent of her drinking?”).
• Enabling and Accommodating: Providing the user with money despite knowing it will fund substance consumption, cleaning up messes, or putting oneself out to nurse the relative after binges (e.g., Item 3: “Put yourself out for her, for example by getting her to bed or by clearing up mess after her after she had been drinking?”; Item 4: “Given her money even when you thought it would be spent on drink?”).
• Despair, Resignation, and Helplessness: Experiencing pervasive paralysis, emotional immobility, and a fatalistic perception that the situation is immutable (e.g., Item 10: “Felt too frightened to do anything?”; Item 14: “Felt too hopeless to do anything?”; Item 23: “Got in a state where you didn’t or couldn’t make any decision?”; Item 24: “Accepted the situation as a part of life that couldn’t be changed?”).

Tolerant-inactive coping demonstrates the strongest, most consistent positive correlations with psychological distress, depression, and somatic strain. Relatives using this strategy often feel trapped, experiencing learned helplessness while inadvertently buffering the user from the natural consequences of addiction.

Withdrawal Coping (CQ-W)

Withdrawal coping involves emotional, psychological, and behavioral disengagement from the user and their addictive episodes. Rather than centering daily life around the substance misuse, the family member redirects their energy toward self-preservation, personal health, and independent social functioning:

• Independent Life and Social Engagement: Carving out a life separate from the relative’s disorder by cultivating external social, recreational, spiritual, or professional networks (e.g., Item 12: “Pursued your own interests or looked for new interests or occupation for yourself, or got more involved in a political, church, sports or other organization?”; Item 29: “Sometimes put yourself first by looking after yourself or giving yourself treats?”).
• Protective Behavioral Distancing: Avoiding the relative during drinking or drug episodes, refusing to intervene in self-inflicted crises, and leaving the relative to manage their own basic needs while intoxicated (e.g., Item 8: “When she was under the influence of drink, left her alone to look after herself or kept out of her way?”; Item 15: “Avoided her as much as possible because of her drinking?”; Item 18: “Got on with your own things or acted as if she wasn’t there?”).
• Prioritizing Family Welfare: Focusing on the physical and psychological safety of other vulnerable family members, especially children, ahead of the addicted relative’s demands (e.g., Item 2: “Put the interests of other members of the family before hers?”).

The scoring architecture of the CQ-W subscale specifically integrates negative weightings for behaviors that represent non-withdrawn, highly involved engagement (Item 5: frank discussion; Item 22: defending the relative from external criticism), reflecting the conceptual principle that withdrawal requires stepping back from both active mediation and protective collusion.

6. Theoretical Framework

The Coping Questionnaire is firmly grounded in the Stress-Strain-Coping-Support (SSCS) model, formulated by Jim Orford, Richard Velleman, Alex Copello, and Lorna Templeton. The SSCS model synthesizes transactional theories of psychological stress—most notably the foundational paradigm of Richard Lazarus and Susan Folkman—with systemic family process theories and ecological community psychology.

The Stress-Strain-Coping-Support (SSCS) Paradigm

The SSCS framework posits that having a relative with an addiction is a chronic, severe life stressor characterized by financial disruption, social embarrassment, domestic conflict, role failure, unpredictability, and, in many cases, threats of violence or safety violations. The fundamental architecture of the model operates across four dynamic, interacting components:

1. Stress: The primary objective conditions and chronic difficulties resulting from the relative’s substance misuse (e.g., money loss, unreliability, legal issues, emotional volatility, domestic upheaval).
2. Strain: The resultant psychological, emotional, and physical wear-and-tear experienced by the family member. Strain is manifested as clinical anxiety, major depression, somatic illnesses (headaches, gastrointestinal issues, insomnia), chronic fatigue, and existential exhaustion.
3. Coping: The specific ways in which the family member appraises the stress and the behavioral, emotional, and cognitive actions taken in response. In the SSCS model, coping acts as a crucial mediating and moderating variable positioned between the objective stressor and the ultimate level of strain experienced.
4. Support: The social, emotional, informational, and material resources available to the family member from informal networks (friends, extended family) and formal agencies. Good quality, non-judgmental support mitigates strain, whereas poor, stigmatizing, or unsupportive social responses amplify it.

Under Lazarus and Folkman’s transactional coping paradigm, cognitive appraisal dictates the emotional and behavioral reaction: primary appraisal evaluates whether the stressor constitutes personal harm, threat, or challenge, while secondary appraisal assesses what, if anything, can be done to manage the threat. In the context of addiction, family members are subjected to chronic ambiguity. The affected relative is physically present but psychologically altered or absent—a state often described in family systems theory as ambiguous loss. Under conditions of ambiguous loss, conventional problem-focused coping frequently collapses because the family member cannot unilaterally control another adult’s chemical dependency.

The SSCS model posits that when family members realize that direct control is impossible, their coping typically swings between extremes: escalating confrontational attempts to exert control (high Engaged coping) or collapsing into defeated compliance and accommodation (high Tolerant coping). Both extremes are psychologically costly. Engaged-emotional coping frequently fuels cyclical domestic arguments, amplifying mutual hostility, whereas Tolerant coping allows the substance use to progress unchecked while internalizing blame, resulting in heightened somatic and depressive strain. The CQ provides the empirical metric necessary to track whether therapeutic interventions can guide relatives toward balanced assertive engagement combined with healthy self-protective withdrawal, effectively decoupling the family member’s emotional survival from the relative’s substance consumption trajectory.

7. Validity

The psychometric validity of the Coping Questionnaire has been evaluated across diverse international cohorts, spanning multiple cultural, demographic, and clinical contexts.

Construct and Structural Validity

Construct validity is evidenced by the consistent emergence of the three hypothesized coping dimensions across distinct cultural cohorts. In the landmark cross-national comparative study by Orford et al. (2001, 2005)—comparing large cohorts of affected family members in southwest England and Mexico City—exploratory and confirmatory factor analyses supported the universality of Engaged, Tolerant, and Withdrawal coping. Despite substantial cross-cultural differences in extended family structure, socio-economic resources, and gender roles, family members in both nations spontaneously organized their coping actions along these three functional dimensions, confirming that the CQ operationalizes universal human coping responses to addiction-induced family stress.

Convergent and Concurrent Validity

Convergent validity is robustly demonstrated through predictable, statistically significant correlations with standard measures of psychological and physical strain, such as the General Health Questionnaire (GHQ-12 / GHQ-28) and the Symptom Rating Test (SRT):

• Tolerant-Inactive Coping (CQ-T): Demonstrates the highest, most consistent positive correlations with family member strain (typical Pearson correlations range from r = .38 to .54, p < .001). Relatives reporting frequent tolerant behaviors (e.g., covering up, making excuses, feeling hopeless or frightened) systematically report higher levels of depressive symptomatology, anxiety, and somatic distress.
• Engaged Coping (CQ-E): Shows moderate to strong positive correlations with symptoms of strain (r values typically between .28 and .45, p < .001), particularly with items measuring interpersonal friction, anger, emotional agitation, and family conflict as measured by the Family Environment Scale (FES).
• Withdrawal Coping (CQ-W): Exhibits either non-significant or slight negative correlations with strain measures once baseline stress is controlled, supporting the theoretical proposition that independent, self-protective withdrawal acts as a buffer against escalating psychological impairment.

Predictive and Discriminant Validity

Predictive validity has been substantiated longitudinally within clinical trials evaluating the 5-Step Intervention. Significant reductions in CQ-T and the emotional/controlling facets of CQ-E from pre- to post-treatment reliably predict long-term reductions in physical and psychological symptoms on the GHQ and SRT at 3-month and 12-month follow-up assessments (p < .01). Discriminant validity is affirmed by low-to-moderate inter-subscale correlations between CQ-W and CQ-E (often ranging from r = -.12 to .20), confirming that the CQ measures distinct behavioral repertoires rather than a single generalized coping orientation.

8. Reliability

The Coping Questionnaire demonstrates solid internal consistency and temporal stability across clinical and community samples of affected family members.

Internal Consistency

In standard validation cohorts (e.g., Orford et al., 2001, 2005; Copello et al., 2010), Cronbach’s alpha coefficients across the primary subscales display acceptable to high internal consistency:

• Engaged Coping Subscale (CQ-E; 14 items): Cronbach’s alpha typically ranges from α = .78 to .87 in British samples and α = .73 to .83 in international translations (including Spanish, Italian, and Portuguese adaptations), indicating robust internal cohesion across its diverse emotional, assertive, and controlling items.
• Tolerant-Inactive Coping Subscale (CQ-T; 9 items): Cronbach’s alpha consistently ranges between α = .68 and .81, reflecting reliable measurement of passivity, resignation, and protective covering-up across varied family relationships.
• Withdrawal Coping Subscale (CQ-W; composite scoring): Cronbach’s alpha values typically span α = .60 to .75. Because CQ-W captures both active independence (e.g., pursuing outside hobbies) and behavioral avoidance (e.g., keeping out of the way when the relative is drinking), alongside reverse-scored items reflecting non-withdrawn communication, its alpha is moderately lower, a recognized characteristic of multifaceted behavioral composite indices.

Test-Retest Reliability and Temporal Stability

In waiting-list control groups and stable non-intervention cohorts evaluated over 6- to 12-week intervals, the CQ exhibits satisfactory test-retest reliability:

• Intraclass correlation coefficients (ICC) and Pearson’s r test-retest coefficients range between .70 and .84 for Engaged Coping, .65 and .79 for Tolerant Coping, and .61 and .74 for Withdrawal Coping.
• These coefficients indicate that while individual coping behaviors possess sufficient structural stability over time, they remain responsive to clinical change following targeted psychological interventions.

9. Factor Analysis

The structural dimensionality of the Coping Questionnaire was established through iterative exploratory factor analyses (EFA) and subsequent confirmatory factor analyses (CFA) across extensive datasets totaling thousands of affected relatives in Europe, Latin America, and Australasia.

Exploratory Factor Structure (EFA)

Initial principal components and principal axis factoring with orthogonal (Varimax) and oblique (Promax / Oblimin) rotations consistently extracted three primary factors accounting for approximately 35% to 44% of the total variance across the 30 items. The three prominent factors correspond directly to the established subscales:

• Factor 1: Engaged Coping. Items loading most heavily (> .40) on this factor reflect emotional confrontation, surveillance, and active attempts to change drinking. Prominent loadings include Item 6 (“Started an argument with her about her drinking”; loadings typically .55–.68), Item 16 (“Got moody or emotional with her”; .50–.65), Item 17 (“Watched her every move or checked up on her”; .52–.64), Item 25 (“Accused her of not loving you”; .48–.62), and Item 28 (“Searched for her drink or hidden or disposed of it”; .44–.58).
• Factor 2: Tolerant-Inactive Coping. High factor loadings (> .40) characterize items measuring resignation, paralysis, and domestic collusion. Key loadings include Item 27 (“Made excuses for her, covered up for her”; .55–.70), Item 30 (“Tried to keep things looking normal, pretended all was well”; .50–.66), Item 14 (“Felt too hopeless to do anything”; .52–.65), Item 10 (“Felt too frightened to do anything”; .48–.61), and Item 23 (“Got in a state where you didn’t or couldn’t make any decision”; .46–.59).
• Factor 3: Withdrawal Coping. Items loading positively on this factor reflect behavioral self-sufficiency and independence, such as Item 12 (“Pursued your own interests or looked for new interests”; .45–.62), Item 18 (“Got on with your own things or acted as if she wasn’t there”; .42–.58), Item 8 (“Left her alone to look after herself or kept out of her way”; .40–.55), and Item 29 (“Sometimes put yourself first”; .41–.54).

Confirmatory Factor Analysis (CFA) and Measurement Invariance

Subsequent structural equation modeling across multicultural samples has tested three-factor versus alternative hierarchical models. While a strict orthogonal three-factor model yields moderate fit due to the intrinsic behavioral overlap among high-stress family dynamics, an oblique three-factor model allowing correlation between Engaged and Tolerant factors provides acceptable model fit indices:

• Root Mean Square Error of Approximation (RMSEA): .048 to .062 (90% CI [.042, .068])
• Comparative Fit Index (CFI): .88 to .93
• Tucker-Lewis Index (TLI): .86 to .91
• Standardized Root Mean Square Residual (SRMR): .051 to .065

Measurement invariance testing across gender (comparing female spouses vs. male spouses/partners) and kinship roles (spouses vs. parents) demonstrates metric and configural invariance, supporting the CQ’s structural robustness for diverse family constellations.

10. Instrument / Measurement Tool

The Coping Questionnaire is a 30-item self-report psychometric inventory designed for rapid paper-and-pencil or digital administration. Below is the operational summary of its structural and scoring attributes:

• Assessment Name: Coping Questionnaire (CQ)
• Authors / Copyright: Jim Orford, Lorna Templeton, Richard Velleman, & Alex Copello; Alcohol, Drugs, Gambling and Addiction Research Group, School of Psychology, The University of Birmingham.
• Construct Measured: Behavioral, emotional, and cognitive coping strategies utilized by family members affected by another person’s alcohol misuse, drug dependence, or gambling problems.
• Item Count: 30 items.
• Target Respondent: Any significant other, partner, spouse, parent, sibling, or adult offspring living with or affected by an individual with an active addiction. (Pronouns in items are adapted to “he/him” or “she/her” depending on the target relative).
• Administration Time: Approximately 8 to 12 minutes.
• Response Format: 4-point ordinal frequency scale:
  • 0 = NO
  • 1 = ONCE OR TWICE
  • 2 = SOMETIMES
  • 3 = OFTEN
• Subscale Composition & Scoring Formulas:
  • Engaged Coping Subscale (CQ-E): Sum the raw scores of the 14 designated items: 1, 5, 6, 7, 9, 11, 13, 16, 17, 19, 21, 25, 26, and 28. Possible score range: 0 to 42. Higher scores indicate more frequent confrontational, assertive, controlling, or emotional responses.
  • Tolerant-Inactive Coping Subscale (CQ-T): Sum the raw scores of the 9 designated items: 3, 4, 10, 14, 20, 23, 24, 27, and 30. Possible score range: 0 to 27. Higher scores indicate greater accommodation, self-blame, resignation, and protective enabling.
  • Withdrawal Coping Subscale (CQ-W): Calculated via a composite algorithm that accounts for positive disengagement and subtracts high-involvement behaviors. Formula:
    
    CQ-W = (Item 2 + Item 8 + Item 12 + Item 15 + Item 18 + Item 29) - (Item 5 + Item 22) + 6
    
    Note: The constant (+6) is added to ensure that the resulting subscale score remains positive. Possible score range: 0 to 24. Higher scores reflect greater independent functioning, self-care, and behavioral detachment.
  • Total Coping Score (CQ-TOT): Summation of general coping activity; Item 5 contributes positively to CQ-TOT and CQ-E, but negatively to CQ-W.

11. Permissions & Fee and Test Year

The Coping Questionnaire was developed and refined across a series of major investigative trials published between 2001 and 2005 by the Alcohol, Drugs, Gambling and Addiction Research Group at the School of Psychology, The University of Birmingham, in conjunction with the Mental Health R&D Unit at the University of Bath. Subsequent refinement and dissemination occurred through the Addiction Family Support and International Network (AFINet) and the National Centre for Education and Training on Addiction (NCETA) at Flinders University.

Permissions and Licensing: The CQ is considered an open-access, non-commercial clinical and research instrument. The authors and copyright holders grant permission for clinicians, healthcare services, and academic researchers to use, reproduce, and administer the Coping Questionnaire free of monetary charge, provided that appropriate scholarly attribution is accorded to the developers and the School of Psychology at the University of Birmingham in any resulting publications, reports, or clinical presentations. Commercial redistribution or sale of the tool within proprietary software suites requires formal written authorization from the copyright holders.

12. References

Below are primary academic references documenting the development, psychometrics, and clinical applications of the Coping Questionnaire:

• Copello, A., Templeton, L., Orford, J., & Velleman, R. (2010). The 5-Step Intervention: Supporting family members facing addiction. Drugs: Education, Prevention and Policy, 17(s1), 159–168. https://doi.org/10.3109/09687637.2010.514798
• Orford, J., Natera, G., Davies, J., Nava, A., Mora, J., Rigby, K., Bradbury, C., Bowie, N., Copello, A., & Velleman, R. (2001). Tolerate, engage or withdraw: A study of the structure of families coping with alcohol and drug problems in south-west England and Mexico City. Addiction, 96(11), 1615–1626. https://doi.org/10.1046/j.1360-0443.2001.961116159.x
• Orford, J., Templeton, L., Velleman, R., & Copello, A. (2005). Family members of relatives with alcohol, drug and gambling problems: A set of standardized questionnaires for assessing stress, coping and strain. Addiction, 100(11), 1611–1624. https://doi.org/10.1111/j.1360-0443.2005.01235.x
• Orford, J., Templeton, L., Velleman, R., & Copello, A. (2010). Methods of assessment for affected family members. Drugs: Education, Prevention and Policy, 17(s1), 75–85. https://doi.org/10.3109/09687637.2010.514783
• Orford, J., Copello, A., Velleman, R., & Templeton, L. (2010). Family members affected by a close relative’s addiction: The 5-Step Intervention. Frontiers in Psychiatry, 1, 149. https://doi.org/10.3389/fpsyt.2010.00149
• Orford, J. (2014). Testing the short questionnaire for family members affected by addiction: Help required. Addiction Family Support and International Network (AFINet). http://www.afinetwork.info/research-articles/371-testing-the-short-questionnaire-for-family-members-affected-by-addiction-help-required
• Velleman, R., Orford, J., Templeton, L., & Copello, A. (2014). The 5-Step Intervention: Supporting family members affected by addiction. In N. El-Guebaly, G. Carrà, & M. Galanter (Eds.), Textbook of Addiction Treatment: International Perspectives (pp. 1157–1172). Springer. https://doi.org/10.1007/978-88-470-5322-9_84

13. Items of the Scale