A set of standardized questionnaires for assessing stress,

coping and strain, for completion by family members of

relatives with alcohol, drug and gambling problems

CONTENTS

Coping Questionnaire and Scoring Key

(Male relative, alcohol problem version) 5 pages

Coping Questionnaire and Scoring Key

(Female relative, alcohol problem version) 5 pages

Other versions relevant to drug or gambling problems are available

Family Member Impact Questionnaire and Scoring Key 4 pages

Symptom Rating Test and Scoring Key 4 pages

Hopefulness-Hopelessness Questionnaire and Scoring Key 3 pages

 November 2005

A set of standardized questionnaires for assessing stress,

coping and strain, for completion by family members of
relatives with alcohol, drug and gambling problems

Jim Orford1, Lorna Templeton2, Richard Velleman2, Alex Copello1

1 Alcohol, Drugs, Gambling and Addiction Research Group, School of

Psychology, The University of Birmingham, and Birmingham and Solihull
Mental Health NHS Trust, Substance Misuse Services, Birmingham, UK
2 Mental Health R&D Unit, University of Bath/Avon and Wiltshire Mental
Health Partnership NHS Trust, Bath, UK

Reference: Orford, J., Templeton, L., Velleman, R. and Copello, A. (2005).

Family members of relatives with alcohol, drug and gambling problems: a set of
standardised questionnaires for assessing stress, coping and strain, Addiction,
100, 1611-1624.
 Male, alcohol version (M,Alc)
Other versions are available
referring to female relatives (F)
and to drugs (D) and
gambling (G)

COPING QUESTIONNAIRE

30-item form

Copyright: Alcohol, Drugs, Gambling and Addiction Research Group, School of

Psychology, The University of Birmingham

1 of 5
 COPING QUESTIONNAIRE

Short 30-item Form

SCORING KEY

Score each item: NO = 0

ONCE OR TWICE = 1
SOMETIMES = 2
OFTEN = 3

FOR TOTAL (CQ-TOT) COPING, sum all 30 items

FOR ENGAGED COPING SUB-SCALE (CQ-E), sum score for items:

1, 5, 6, 7, 9, 11, 13, 16, 17, 19, 21, 25, 26, 28

FOR TOLERANT COPING SUB-SCALE (CQ-T), sum scores for items:

3, 4, 10, 14, 20, 23, 24, 27, 30

FOR WITHDRAWAL COPING SUB-SCLAE (CQ-W) sum scores for items:

2, 8, 12, 15, 18, 29 and subtract scores for items 5 and 22:

and then add 6 (to ensure all values for CQ-W are positive)

(N.B. – Item 5 contributes positively to CQ-TOT and CQ-E, but negatively to

CQ-W)

2 of 5
 Have you recently (in the last 3 months)

Please circle one answer

1 Refused to lend him money or to help NO ONCE OR SOMETIMES OFTEN

him out financial in other ways? TWICE

2 Put the interests of other members of the NO ONCE OR SOMETIMES OFTEN

family before his? TWICE

3 Put yourself out for him, for example by NO ONCE OR SOMETIMES OFTEN
getting him to bed or by clearing up TWICE
mess after him after he had been
drinking?

4 Given him money even when you NO ONCE OR SOMETIMES OFTEN

thought it would be spent on drink? TWICE

5 Sat down together with him and talked NO ONCE OR SOMETIMES OFTEN
frankly abut what could be done about TWICE
his drinking?

6 Started an argument with him about his NO ONCE OR SOMETIMES OFTEN

drinking? TWICE

7 Pleaded with him about his consumption NO ONCE OR SOMETIMES OFTEN

of alcohol? TWICE

8 When he was under the influence of NO ONCE OR SOMETIMES OFTEN

drink, left him alone to look after TWICE
himself or kept out of his way?

9 Made it quite clear to him that his NO ONCE OR SOMETIMES OFTEN

drinking was causing you upset and that TWICE
it had got to change?

10 Felt too frightened to do anything? NO ONCE OR SOMETIMES OFTEN

TWICE

11 Tried to limit his drinking by making NO ONCE OR SOMETIMES OFTEN

some rule about it, for example TWICE
forbidding drinking in the house, or
stopping him bringing drinking friends
home?

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 2 of 4

Have you recently (in the last 3 months)

Please circle one answer

12 Pursued your own interests or looked for NO ONCE OR SOMETIMES OFTEN

new interests or occupation for yourself, TWICE
or got more involved in a political,
church, sports or other organisation?

13 Encouraged him to take an oath or NO ONCE OR SOMETIMES OFTEN

promise not to drink? TWICE

14 Felt too hopeless to do anything? NO ONCE OR SOMETIMES OFTEN

TWICE

15 Avoided him as much as possible NO ONCE OR SOMETIMES OFTEN

because of his drinking? TWICE

16 Got moody or emotional with him? NO ONCE OR SOMETIMES OFTEN

TWICE

17 Watched his every move or checked up NO ONCE OR SOMETIMES OFTEN

on him or kept a close eye on him? TWICE

18 Got on with your own things or acted as NO ONCE OR SOMETIMES OFTEN

if he wasn’t there? TWICE

19 Made it clear that you won’t accept his NO ONCE OR SOMETIMES OFTEN
reasons for drinking, or cover up for TWICE
him?

20 Made threats that you didn’t really mean NO ONCE OR SOMETIMES OFTEN
to carry out? TWICE

21 Made clear to him your expectations of NO ONCE OR SOMETIMES OFTEN

what he should do to contribute to the TWICE
family?

22 Stuck up for him or stood by him when NO ONCE OR SOMETIMES OFTEN

others were criticising him? TWICE

23 Got in a state where you didn’t or NO ONCE OR SOMETIMES OFTEN

couldn’t make any decision? TWICE

24 Accepted the situation as a part of life NO ONCE OR SOMETIMES OFTEN

that couldn’t be changed? TWICE

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 Have you recently (in the last 3 months)

Please circle one answer

25 Accused him of not loving you, or of NO ONCE OR SOMETIMES OFTEN

letting you down? TWICE

26 Sat down with him to help him sort out NO ONCE OR SOMETIMES OFTEN
the financial situation? TWICE

27 When things have happened as a result NO ONCE OR SOMETIMES OFTEN

of his drinking, made excuses for him, TWICE
covered up for him, or taken the blame
yourself?

28 Searched for his drink or hidden or NO ONCE OR SOMETIMES OFTEN

disposed of it yourself? TWICE

29 Sometimes put yourself first by looking NO ONCE OR SOMETIMES OFTEN

after yourself or giving yourself treats? TWICE

30 Tried to keep things looking normal, NO ONCE OR SOMETIMES OFTEN

pretended all was well when it wasn’t or TWICE
hidden the extent of his drinking?

5 of 5
 Female, alcohol version (F,Alc)
Other versions are available
referring to male relatives (M)
and to drugs (D) and
gambling (G)

COPING QUESTIONNAIRE

30-item form

Copyright: Alcohol, Drugs, Gambling and Addiction Research Group, School of

Psychology, The University of Birmingham

1 of 5
 COPING QUESTIONNAIRE

Short 30-item Form

SCORING KEY

Score each item: NO = 0

ONCE OR TWICE = 1
SOMETIMES = 2
OFTEN = 3

FOR TOTAL (CQ-TOT) COPING, sum all 30 items

FOR ENGAGED COPING SUB-SCALE (CQ-E), sum score for items:

1, 5, 6, 7, 9, 11, 13, 16, 17, 19, 21, 25, 26, 28

FOR TOLERANT COPING SUB-SCALE (CQ-T), sum scores for items:

3, 4, 10, 14, 20, 23, 24, 27, 30

FOR WITHDRAWAL COPING SUB-SCLAE (CQ-W) sum scores for items:

2, 8, 12, 15, 18, 29 and subtract scores for items 5 and 22:

and then add 6 (to ensure all values for CQ-W are positive)

(N.B. – Item 5 contributes positively to CQ-TOT and CQ-E, but negatively to

CQ-W)

2 of 5
 Have you recently (in the last 3 months)

Please circle one answer

1 Refused to lend her money or to help her NO ONCE OR SOMETIMES OFTEN

out financial in other ways? TWICE

2 Put the interests of other members of the NO ONCE OR SOMETIMES OFTEN

family before hers? TWICE

3 Put yourself out for her, for example by NO ONCE OR SOMETIMES OFTEN
getting her to bed or by clearing up mess TWICE
after her after she had been drinking?

4 Given her money even when you thought NO ONCE OR SOMETIMES OFTEN
it would be spent on drink? TWICE

5 Sat down together with her and talked NO ONCE OR SOMETIMES OFTEN
frankly about what could be done about TWICE
her drinking?

6 Started an argument with her about her NO ONCE OR SOMETIMES OFTEN

drinking? TWICE

7 Pleaded with her about her consumption NO ONCE OR SOMETIMES OFTEN

of alcohol? TWICE

8 When she was under the influence of NO ONCE OR SOMETIMES OFTEN

drink, left her alone to look after herself or TWICE
kept out of her way?

9 Made it quite clear to her that her drinking NO ONCE OR SOMETIMES OFTEN
was causing you upset and that it had got TWICE
to change?

10 Felt too frightened to do anything? NO ONCE OR SOMETIMES OFTEN

TWICE

11 Tried to limit her drinking by making NO ONCE OR SOMETIMES OFTEN

some rule about it, for example forbidding TWICE
drinking in the house, or stopping her
bringing drinking friends home?

3 of 5
 Have you recently (in the last 3 months)

Please circle one answer

12 Pursued your own interests or looked for NO ONCE OR SOMETIMES OFTEN

new interests or occupation for yourself, TWICE
or got more involved in a political,
church, sports or other organisation?

13 Encouraged her to take an oath or promise NO ONCE OR SOMETIMES OFTEN

not to drink? TWICE

14 Felt too hopeless to do anything? NO ONCE OR SOMETIMES OFTEN

TWICE

15 Avoided her as much as possible because NO ONCE OR SOMETIMES OFTEN

of her drinking? TWICE

16 Got moody or emotional with her? NO ONCE OR SOMETIMES OFTEN

TWICE

17 Watched her every move or checked up NO ONCE OR SOMETIMES OFTEN

on her or kept a close eye on her? TWICE

18 Got on with your own things or acted as if NO ONCE OR SOMETIMES OFTEN

she wasn’t there? TWICE

19 Made it clear that you won’t accept her NO ONCE OR SOMETIMES OFTEN
reasons for drinking, or cover up for her? TWICE

20 Made threats that you didn’t really mean NO ONCE OR SOMETIMES OFTEN
to carry out? TWICE

21 Made clear to her your expectations of NO ONCE OR SOMETIMES OFTEN

what she should do to contribute to the TWICE
family?

22 Stuck up for her or stood by her when NO ONCE OR SOMETIMES OFTEN

others were criticising her? TWICE

23 Got in a state where you didn’t or couldn’t NO ONCE OR SOMETIMES OFTEN

make any decision? TWICE

24 Accepted the situation as a part of life that NO ONCE OR SOMETIMES OFTEN

couldn’t be changed? TWICE

4 of 5
 Have you recently (in the last 3 months)

Please circle one answer

25 Accused her of not loving you, or of NO ONCE OR SOMETIMES OFTEN

letting you down? TWICE

26 Sat down with her to help her sort out the NO ONCE OR SOMETIMES OFTEN
financial situation? TWICE

27 When things have happened as a result of NO ONCE OR SOMETIMES OFTEN

her drinking, made excuses for her, TWICE
covered up for her, or taken the blame
yourself?

28 Searched for her drink or hidden or NO ONCE OR SOMETIMES OFTEN

disposed of it yourself? TWICE

29 Sometimes put yourself first by looking NO ONCE OR SOMETIMES OFTEN

after yourself or giving yourself treats? TWICE

30 Tried to keep things looking normal, NO ONCE OR SOMETIMES OFTEN

pretended all was well when it wasn’t or TWICE
hidden the extent of her drinking?

5 of 5
 FAMILY MEMBER IMPACT QUESTIONNAIRE

16-item form

Copyright: Alcohol, Drugs and the Family Group, Universities of Birmingham

and Bath; Birmingham and Solihull Mental Health NHS Trust; Avon and
Wiltshire Mental Health Partnership NHS Trust

1 of 4
 FAMILY MEMBER IMPACT QUESTIONNAIRE

16-item form

SCORING KEY

Score each item:

Not at all = 0

Once or twice = 1

Sometimes = 2

Often = 3

Don’t know*

Items 3, 6, 7 = 1

All other items = 2

*If there are more than 3 don’t knows, do not score the questionnaire

FOR TOTAL IMPACT, sum all items

FOR WORRYING BEHAVIOUR, sum items 3, 4, 8, 9, 11, 12, 13, 14, 15, 16

FOR ACTIVE DISTURBANCE, sum items 1, 2, 5, 6, 7, 10

2 of 4
To your knowledge, have any of the following happened in the last 3 months, as a
result of your relative’s drinking/drug use? Please tick one answer to each question

Not at all Once or Sometimes Often Don’t

twice know

1. Does your relative have

very changeable moods?

2. Does your relative

communicate badly?

3. Does your relative steal

or borrow money and not
pay it back?

4. Have the family’s

finances been affected?

5. Does your relative pick

quarrels with you?

6. Has your relative

sometimes threatened you?

7. Have people outside the

family had to get involved?

8. Does your relative come

and go at irregular or
awkward times?

9. Does your relative’s

drinking/drug use get in the
way of your social life?

10. Has your relative upset

family occasions?

11. Does your relative fail to

join in family activities?

12. Has your relative been

late or unreliable?

13. Are you worried that

your relative’s ability to
work or study has been
affected by the
drinking/drug use?

3 of 4
14. Are you worried that
your relative’s physical
health has been affected by
the drinking/drug use?

15. Are you worried that

your relative has neglected
his/her appearance or self-
care?

16. Are you worried that

your relative’s mental state
is becoming affected by the
drinking/drug use?

4 of 4
 SYMPTOM RATING TEST

30 items

Source: Kellner, R. and Sheffield, B. (1973). A self-rating scale of distress,

Psychological Medicine, 3, 88-100.

1 of 4
 SYMPTOM RATING TEST

30 items

SCORING KEY

Score each item:

Never = 0

Sometimes = 1

Often = 2

For TOTAL SYMPTOMS, sum all 30 items

For PSYCHOLOGICAL SYMPTOMS, sum the following 18 items: 3, 5, 8, 9, 10, 12,

13, 15, 17, 18, 19, 20, 22, 23, 24, 25, 26, 28

For PHYSICAL SYMPTOMS, sum the following 12 items: 1, 2, 4, 6, 7, 11, 14, 16,
21, 27, 29, 30

2 of 4
How frequently have you experienced each of the following symptoms in the last 3
months? Please tick one answer to each question
Never Sometimes Often

1. Feeling dizzy or faint

2. Feeling tired or lack of energy

3. Feeling nervous

4. Feeling pressure or tightness in

the head

5. Feeling scared or frightened

6. Poor appetite

7. Heart beating quickly or strongly

without reason (throbbing or
pounding)

8. Feeling that there was no hope

9. Restless or jumpy

10. Poor memory

11. Chest pains or breathing

difficulties or feeling of not having
enough air

12. Feeling guilty

13. Worrying

14. Muscle pains, aches or

rheumatism

15. Feeling that people look down

on you or think badly of you

16. Trembling or shaking

17. Difficulty in thinking clearly or

difficulty in making up your mind

18. Feeling unworthy or a failure

19. Feeling tense or ‘wound up’

3 of 4
20. Feeling inferior to other people

21. Parts of your body feel numb or

tingling

22. Irritable

23. Thoughts that you cannot push

out of your mind

24. Lost interest in most things

25. Unhappy or depressed

26. Attacks of panic

27. Parts of the body feel weak

28. Cannot concentrate

29. It takes a long time to fall asleep,

or restless sleep, or nightmares

30. Awakening early and not being

able to fall asleep again

4 of 4
 HOPEFULNESS-HOPELESSNESS QUESTIONNAIRE

10-item form

Original Source: Micallef, P.D. (1995). Families of illicit drug users. Doctor of Clinical
Psychology Thesis, University of Birmingham

Copyright: Alcohol, Drugs and the Family Group, Universities of Birmingham and
Bath; Birmingham and Solihull Mental Health NHS Trust; Avon and Wiltshire Mental
Health Partnership NHS Trust

1 of 3
 HOPEFULNESS-HOPELESSNESS SCALE

10-item form

SCORING KEY

Score items as follows:

Items Items
1, 5, 8, 9, 10 2, 3, 4, 6, 7

Strongly agree = 5 1

Agree = 4 2

Don’t know = 3 3

Disagree = 2 4

Strongly disagree = 1 5

For TOTAL HOPE score, sum all 10 items

2 of 3
 How do you feel about the future now? Please tick one answer to each question

Strongly Agree Don’t Disagree Strongly

agree know disagree

1. I am now starting
to anticipate a new
future

2. I’m fearful about

how my relative will
get on

3. My relative’s not
looking at things
seriously enough

4. I’m pessimistic
about the immediate
future

5. I believe that out of

this will come
something really
good for my relative

6. There’s never
going to be any
change, my relative’s
stuck

7. I worry that my
relative’s going to go
on drinking/taking
drugs until the end

8. Things are
beginning to pick up

9. I’m starting to get

back the person I
knew

10. I feel more

positive about things
now

3 of 3