Coping Questionnaire

Abstract

The Coping Questionnaire (CQ) is a prominent, psychometrically validated self-report instrument developed to assess the coping behaviors, strategies, and behavioral responses of affected family members (AFMs)—such as spouses, parents, siblings, and adult children—confronting the alcohol, substance misuse, or addictive behaviors of a significant other. Conceptualized within the foundational Stress-Strain-Coping-Support (SSCS) model formulated by Jim Orford, Richard Velleman, Alex Copello, and Lorna Templeton, the CQ was constructed to replace stigmatizing, pathologizing paradigms (such as traditional notions of “codependency”) with an empirical, stress-and-coping framework. The scale comprises 30 items evaluated along a 4-point frequency rating scale ranging from 0 (“No”) to 3 (“Often”), typically capturing behaviors enacted over the preceding three months.

Extensive psychometric investigations have established that the instrument measures three primary, factorially distinct dimensions of familial coping: Engaged Coping (active, assertive, or emotional attempts to change, intervene, or control the relative’s substance use; 14 items), Tolerant-Inactive Coping (submissive, accommodating, resigned, or self-sacrificing behavior that inadvertently accepts or covers up the relative’s behavior; 9 items), and Withdrawal Coping (emotional, psychological, or behavioral detachment wherein family members prioritize their own independence, well-being, and individual life pursuits; 8 scoring items calculated via an adjusted composite algorithm). The CQ demonstrates robust psychometric properties across both clinical and community settings internationally. Subscale internal consistency estimates (Cronbach’s alpha) reliably range from 0.72 to 0.86. Construct, convergent, and discriminant validities are substantiated by predictable inter-correlations with psychological strain (measured via instruments such as the General Health Questionnaire), physical symptoms, domestic conflict, and perceived social support. The CQ serves as an essential assessment tool in clinical psychology, family therapy, epidemiological research, and evidence-based addiction interventions such as the 5-Step Intervention.

Keywords

Coping Questionnaire, Affected Family Members, Addiction, Substance Misuse, Stress-Strain-Coping-Support Model, Engaged Coping, Tolerant Coping, Withdrawal Coping, Psychometrics, Family Systems

Authors

The Coping Questionnaire was developed by the Alcohol, Drugs, Gambling and Addiction Research Group, based across the School of Psychology at the University of Birmingham and the Department of Psychology at the University of Bath, United Kingdom.

• Jim Orford, PhD, FBPsS: Emeritus Professor of Clinical and Community Psychology, School of Psychology, University of Birmingham, Birmingham, United Kingdom.
• Lorna Templeton, MSc: Independent Research Consultant and Senior Research Fellow, Mental Health R&D Unit, University of Bath and Avon and Wiltshire Mental Health Partnership NHS Trust, United Kingdom.
• Richard Velleman, PhD, FBPsS: Emeritus Professor of Mental Health Research, Department of Psychology, University of Bath, Bath, United Kingdom, and Co-Director of Sangath, Goa, India.
• Alex Copello, PhD, FBPsS: Professor of Addiction Psychology, School of Psychology, University of Birmingham, and Consultant Clinical Psychologist, Birmingham and Solihull Mental Health NHS Foundation Trust, United Kingdom.

Purpose

Addiction within a family unit exerts profound psychological, financial, somatic, and social strain on relatives. Historically, psychological literature conceptualized family members of individuals with substance use disorders through pathologizing constructs, notably labeling partners and family members as “codependent” or “enablers” who allegedly possessed underlying personality deficits that unconsciously maintained the addiction. The primary purpose of the Coping Questionnaire (CQ) was to dismantle these unverified, disease-oriented assumptions by providing a non-pathologizing, objective, and standardized psychometric instrument rooted in transactional coping theory.

The CQ systematically evaluates how an affected relative copes with a focal family member’s drinking, illicit drug use, or problematic gambling. The instrument is engineered to operationalize coping as a normative, dynamic behavioral reaction to an extraordinary, severe chronic stressor, rather than a manifestation of individual personality pathology. In clinical contexts, the CQ fulfills several vital functions:

• Baseline Clinical Assessment: It identifies the predominant coping repertoire adopted by the family member, pinpointing high-risk coping mechanisms (e.g., self-blame, extreme emotional escalation, severe accommodation, or paralyzing hopelessness) that exacerbate psychological strain.
• Intervention Guidance: It serves as a tailored guide within interventions like the 5-Step Method, Community Reinforcement and Family Training (CRAFT), and behavioral couples therapy, assisting clinicians in reinforcing constructive coping while discouraging ineffective strategies.
• Outcome Measurement: Administered pre- and post-intervention, the CQ provides sensitive indices of behavioral change, tracking reductions in harmful engaged confrontation or self-defeating tolerant accommodation alongside healthy increases in self-care, assertive communication, and adaptive emotional independence.

In epidemiological and clinical research, the CQ provides a uniform psychometric tool that enables cross-cultural comparisons of how differing sociocultural norms, kinship networks, and social welfare environments shape familial responses to chronic addiction.

Psychological Construct

The CQ conceptualizes coping as the cognitive and behavioral efforts executed by an individual to master, tolerate, reduce, or minimize the stressful demands and interpersonal conflicts generated by a loved one’s addictive behavior. Rather than viewing coping through rigid generalist categorizations (such as simple “problem-focused” versus “emotion-focused” coping), the CQ captures the multidimensional, relational reality of living with an addicted family member. Factor-analytic and clinical derivations identify three distinct psychological constructs:

1. Engaged Coping (CQ-E)

Engaged Coping encompasses direct, active involvement in the user’s problem behavior. It reflects behaviors wherein the family member actively confronts, controls, monitors, manages, or responds emotionally to the relative’s drinking, drug taking, or gambling. Rather than representing a monolithic adaptive strategy, engaged coping contains diverse nuances:

• Assertive / Open Communication: Frank dialogue about the drinking problem (e.g., Item 5: sitting down together to discuss what can be done; Item 9: expressing upset and demanding change).
• Emotional / Escalating Responses: Arguments, accusations, emotional volatility, and pleading (e.g., Item 6: starting an argument; Item 7: pleading; Item 16: getting moody or emotional; Item 25: accusing the relative of not loving them).
• Controlling / Investigative Behaviors: Surveillance, setting restrictive rules, and confiscation (e.g., Item 11: establishing home drinking rules; Item 17: monitoring every move; Item 28: searching for, hiding, or disposing of alcohol).

Empirical evidence indicates that high, pervasive levels of reactive, emotionally charged engaged coping are frequently correlated with elevated levels of psychological strain, anxiety, and interpersonal friction.

2. Tolerant-Inactive Coping (CQ-T)

Tolerant-Inactive Coping captures submissive, resigned, accommodating, or collusive behaviors where the family member puts up with the addictive behavior, makes compromises, shields the relative from the natural consequences of addiction, or feels entirely helpless to intervene. Behaviors reflecting this construct include:

• Enabling and Accommodating: Providing funds that will be used for alcohol (Item 4), clearing up mess or getting the intoxicated relative to bed (Item 3), and covering up or taking the blame for the relative’s actions (Item 27, Item 30).
• Resignation and Inaction: Experiencing paralysis or fatalism (Item 10: feeling too frightened to act; Item 14: feeling too hopeless; Item 23: inability to make decisions; Item 24: accepting the situation as an unchangeable fate).
• Empty Threats: Making ultimatums or threats without following through (Item 20).

Tolerant-inactive coping is consistently linked to the highest levels of familial distress, depression, physical somatic symptoms, and prolonged entrapment in the cycle of addiction.

3. Withdrawal Coping (CQ-W)

Withdrawal Coping captures behavioral, psychological, and emotional independence. The affected family member disengages from the relative’s addictive crises to preserve their own psychological integrity, physical health, and personal life. Key facets include:

• Behavioral Detachment and Avoidance: Leaving the relative alone when under the influence (Item 8) and avoiding the relative because of their drinking (Item 15).
• Pursuing Independent Life: Engaging in personal hobbies, career pursuits, or social, church, sports, and political organizations (Item 12), prioritizing other family members’ needs (Item 2), and taking care of oneself with personal treats (Item 29).
• Psychological Disengagement: Acting as if the relative is not present (Item 18).

Withdrawal coping does not signify abandonment or callous apathy; rather, it reflects adaptive emotional differentiation and self-preservation. Empirical findings show that increases in withdrawal coping frequently correlate with reductions in chronic strain, empowering family members to rebuild personal boundaries.

Theoretical Framework

The CQ is grounded in the Stress-Strain-Coping-Support (SSCS) model, articulated by Orford, Velleman, Copello, Templeton, and colleagues across more than three decades of cross-cultural inquiry. The SSCS model synthesizes Richard Lazarus and Susan Folkman’s transactional theory of stress and coping with structural family systems theory and ecological psychology.

The theoretical model delineates five interconnected operational components:

1. Stress: Chronic exposure to the relative’s addictive actions, mood disruptions, unpredictable behavior, financial crises, and domestic threats constitutes an extreme, ongoing environmental stressor.
2. Strain: The physiological, psychological, and psychosomatic toll sustained by the family member, encompassing clinical depression, generalized anxiety, demoralization, hypertension, and somatic symptoms.
3. Coping: The cognitive appraisals and behavioral actions undertaken by the family member to moderate, endure, or mitigate the primary stressor. The SSCS model posits that coping acts both as a mediator and a moderator between addictive stress and family strain.
4. Support: The presence, quality, and nature of the relative’s social network. Support can be positive (emotional validation, material aid) or negative (judgment, unhelpful advice, blame).
5. Information: The family member’s cognitive understanding of the nature of addiction, which shapes their cognitive appraisals and subsequent coping attempts.

A core tenet of the SSCS framework is that the coping actions of family members are normative, rational attempts to adapt to an abnormal, deeply distressing crisis. When an individual witnesses their partner, child, or parent succumb to severe substance misuse, typical initial reactions involve active engagement (monitoring, reasoning, or arguing) to resolve the problem. If addiction persists, the relative frequently alternates between desperate tolerance (giving in, shielding the family from external shame) and protective withdrawal (distancing to preserve personal sanity). The CQ captures this cyclical, dynamic process without imposing diagnostic labels of psychopathology on the family member.

Validity

The validity of the Coping Questionnaire has been evaluated across international, multi-site studies encompassing diverse socio-demographic, cultural, and clinical samples across the United Kingdom, Mexico, Italy, Australia, and India.

Construct and Structural Validity

Construct validity is supported by confirmatory and exploratory factor analyses demonstrating stable convergence around the tripartite model: Engaged, Tolerant-Inactive, and Withdrawal coping. Multi-group structural invariance studies demonstrate that the underlying factor structure remains consistent across different relative relationships (spouses vs. parents vs. adult children) and across substances of abuse (alcohol, opioids, stimulants, and problem gambling).

Convergent and Concurrent Validity

The CQ demonstrates marked convergent validity when correlated against standardized measures of physical and mental health:

• Tolerant-Inactive Coping (CQ-T): Demonstrates strong, statistically significant positive correlations with psychological strain as assessed by the General Health Questionnaire (GHQ-12) ($r = .40\text{ to }.55, p < .001$) and the Symptom Rating Test (SRT). Relatives scoring high on tolerant coping exhibit the highest rates of depressive symptomatology, demoralization, and somatic complaints.
• Engaged Coping (CQ-E): Moderately correlates with general psychological strain ($r = .25\text{ to }.42, p < .01$) and correlates heavily with domestic conflict, marital distress, and perceived chronic daily hassles.
• Withdrawal Coping (CQ-W): Exhibits inverse or non-significant correlations with psychological distress in cross-sectional studies, and predicts longitudinal decreases in strain ($r = -.20\text{ to }-.35, p < .05$) when family members transition out of passive tolerance into active self-care and autonomy.

Discriminant and Criterion Validity

Discriminant validity is evidenced by the CQ’s capacity to differentiate between distinct clinical subgroups. Family members in active, untreated addiction environments score significantly higher on CQ-T and the confrontational elements of CQ-E than family members whose relatives are in sustained recovery or who participate in mutual-help groups such as Al-Anon. Longitudinal treatment studies (such as the UK Alcohol Treatment Trial [UKATT] and evaluations of the 5-Step Intervention) demonstrate high criterion-related predictive sensitivity: therapeutic reductions in CQ-T and maladaptive CQ-E scores directly mediate substantial improvements in family member physical health, domestic peace, and subjective quality of life.

Reliability

The Coping Questionnaire exhibits strong internal consistency, temporal stability, and measurement precision across heterogeneous clinical and community cohorts.

Internal Consistency

Standardized reliability analyses across numerous validation trials indicate acceptable to high internal consistency coefficients (Cronbach’s alpha) across the subscales:

• Engaged Coping (CQ-E): Demonstrates excellent internal consistency, with published $\alpha$ coefficients typically ranging between .81 and .86. This reflects high item-total correlation across its 14 composite indicators.
• Tolerant-Inactive Coping (CQ-T): Demonstrates robust reliability, with $\alpha$ coefficients consistently between .75 and .82 across English, Spanish, and Italian language adaptations.
• Withdrawal Coping (CQ-W): Shows adequate internal consistency, generally yielding $\alpha$ values between .68 and .76. The slightly lower alpha is attributable to the reverse-weighting scoring formula and the broad behavioral diversity inherent to withdrawal behaviors (ranging from pursuing independent hobbies to complete physical avoidance).

Test-Retest Stability

In stability studies evaluating untreated family cohorts over test-retest intervals of 6 to 12 weeks, intra-class correlation coefficients (ICC) and Pearson correlation coefficients ranged from $r = .70\text{ to }.83$, confirming satisfactory longitudinal stability in the absence of clinical intervention. Simultaneously, the instrument preserves high responsiveness and sensitivity to change following targeted psychosocial interventions.

Factor Analysis

The factorial architecture of the CQ was initially mapped through exploratory factor analysis (EFA) using principal axis factoring with oblique (Oblimin/Promax) rotations to account for theoretical correlations between coping behaviors. Subsequent psychometric research has verified this structure using confirmatory factor analysis (CFA).

Exploratory Factor Solutions

Initial EFA runs on samples of affected family members yielded a robust three-factor solution explaining between 42% and 51% of total variance:

• Factor 1 (Engaged Coping): Salient loadings ($λ ge .40$, ranging up to $.72$) observed for items involving emotional reactions (e.g., arguing, pleading), control mechanisms (e.g., searching for hidden bottles, setting household bans), and direct confrontation.
• Factor 2 (Tolerant-Inactive Coping): Distinct high factor loadings ($λ = .45\text{ to }.68$) for items capturing resignation, paralysis, financial enabling, and making excuses for the relative.
• Factor 3 (Withdrawal Coping): Substantial positive loadings for items reflecting independent activities, social network engagement, and physical avoidance of the intoxicated individual. Items 5 (talking frankly) and 22 (sticking up for the relative) loaded negatively onto this factor, demonstrating their conceptual opposition to disengagement and justifying their subtraction in the scoring algorithm.

Confirmatory Factor Analysis Fit Indices

In structural equation modeling validations, the three-factor model exhibits satisfactory fit metrics:

• Comparative Fit Index (CFI) $ge .90$ to $.94$
• Tucker-Lewis Index (TLI) $ge .89$ to $.93$
• Root Mean Square Error of Approximation (RMSEA) $le .054$ to $.062$ ($90%\text{ CI } [.048, .068]$)
• Standardized Root Mean Square Residual (SRMR) $le .061$

Alternative single-factor (unidimensional coping) or two-factor models produce significantly degraded fit indices ($Δ\chi^2, p < .001$), confirming that familial coping cannot be reduced to a simple active/passive dichotomy.

Instrument / Measurement Tool

• Test Type: Standardized self-report psychometric rating scale / clinical inventory.
• Target Population: Adult family members, partners, parents, adult children, or significant others affected by another person’s alcohol misuse, drug dependence, or addictive behavior.
• Administration Format: Paper-and-pencil or secure computer/digital administration; self-administered or completed via structured interview.
• Item Count: 30 items.
• Administration Time: Approximately 8 to 12 minutes.
• Time Frame: Behaviors enacted during the preceding 3 months.
• Response Scale: 4-point categorical frequency scale:
  • 0 = NO (Did not occur / Never)
  • 1 = ONCE OR TWICE
  • 2 = SOMETIMES
  • 3 = OFTEN
• Scoring and Subscale Calculation Rules:
  • Engaged Coping Subscale (CQ-E): Sum the raw scores of 14 items:
    
    CQ-E = Item 1 + Item 5 + Item 6 + Item 7 + Item 9 + Item 11 + Item 13 + Item 16 + Item 17 + Item 19 + Item 21 + Item 25 + Item 26 + Item 28
    
    Score Range: 0 to 42.
  • Tolerant-Inactive Coping Subscale (CQ-T): Sum the raw scores of 9 items:
    
    CQ-T = Item 3 + Item 4 + Item 10 + Item 14 + Item 20 + Item 23 + Item 24 + Item 27 + Item 30
    
    Score Range: 0 to 27.
  • Withdrawal Coping Subscale (CQ-W): Sum the raw scores of 6 positive detachment items, subtract the scores of 2 engagement/defense items, and add a constant of 6 to guarantee all final scores remain non-negative:
    
    CQ-W = (Item 2 + Item 8 + Item 12 + Item 15 + Item 18 + Item 29) - (Item 5 + Item 22) + 6
    
    Score Range: 0 to 24 (Theoretical range after adjustment).
  • Total Coping Score (CQ-TOT): Sum of all standard item scores according to full directional weighting. Item 5 contributes positively to CQ-TOT and CQ-E, but negatively to CQ-W.

Permissions & Fee and Test Year

• Year of Publication: 2005 (formal primary psychometric validation by Orford et al.); initial developmental prototypes originated in the 1970s and 1990s.
• Copyright Holder: Alcohol, Drugs, Gambling and Addiction Research Group, School of Psychology, The University of Birmingham.
• Access & Permissions: The Coping Questionnaire is classified as an open-access academic instrument for research and clinical non-profit applications. It was made publicly accessible via university repositories and academic health service partnerships (e.g., Flinders University NCETA repository, Addiction Family Support Network [AFINet]). No licensing fees or royalties are required for non-commercial academic research, public healthcare utilization, or registered clinical charity operations, provided proper formal bibliographic citation is accorded to the original authors. Commercial licensing or inclusion in commercial digital platforms requires written consent from the copyright-holding research group.

References

• Copello, A., Templeton, L., Orford, J., & Velleman, R. (2010). The 5-Step Method: Principles and practice. Drugs: Education, Prevention and Policy, 17(s1), 86–99. https://doi.org/10.3109/09687637.2010.515186
• Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. Springer Publishing Company.
• Orford, J., Natera, G., Copello, A., Holmes, D., Velleman, R., Bradbury, C., Templeton, L., & Zabaleta, M. (2001). Coping with alcohol and drug problems: The experiences of family members in three contrasting cultures. Addiction Research & Theory, 9(3), 201–219. https://doi.org/10.3109/16066350109141750
• 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.1360-0443.2005.01224.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. (2014). Testing the short questionnaire for family members affected by addiction: Help required. Addiction Family Support Network (AFINet). http://www.afinetwork.info
• Velleman, R., Templeton, L., & Copello, A. (2005). The role of the family in preventing and intervening with substance use and misuse: A comprehensive review of family interventions, with a focus on young people. Adolescent Addiction: Psychopathology, Assessment, and Treatment, 16(2), 93–109.

Items of the Scale