How Concurrent Disorders Affect Family Life

Abstract

The collection of instruments referred to collectively as the “How Concurrent Disorders Affect Family Life” tools—including the Preoccupation and Impact Scale (PIS), the Family Concurrent Disorders Index of Concerns Quiz (FCDIC), and the Readiness to Change Ruler—are designed to assess the multifaceted caregiver burden experienced by family members supporting a loved one with concurrent disorders (co-occurring mental illness and substance use problems). These tools provide a structured method for families to quantify the impact of the illness on their physical, emotional, social, and spiritual well-being, moving beyond simple qualitative descriptions to evaluate preoccupation levels, specific areas of concern, and motivation for self-care and intervention.

Keywords

Concurrent disorders, caregiver burden, family impact, substance use, mental health, emotional health, psychological assessment, family support, readiness to change, dual diagnosis.

Authors

C.P. O’Grady, W.J. Skinner, T.M. Kashner, L.E. Rader, D.E. Rodell, et al.

Purpose

The primary purpose of these instruments is two-fold: first, to provide family members with a structured, introspective framework to identify and articulate the profound negative impacts of supporting a relative with concurrent disorders; and second, to serve as a clinical tool for professionals to gauge the severity of family burden and the family’s stage of readiness for seeking help or implementing change. The tools facilitate discussion about the caregiver’s personal health (physical, emotional, spiritual) and the overall functioning of the family unit, which are often neglected when the focus is solely on the afflicted individual.

Specifically, the Preoccupation and Impact Scale measures the extent to which the family member’s thoughts and daily life are dominated by the loved one’s illness, while the Index of Concerns Quiz systematically maps out immediate and long-term worries across various life domains (e.g., financial, physical health, recovery). The instruments are intended for use in family-focused addiction and mental health intervention programs.

Construct

The central construct measured is Family Burden and Coping Capacity in the context of concurrent disorders. This construct is broken down into several measurable dimensions: 1) Level of Preoccupation (the cognitive and behavioral centrality of the illness to the caregiver’s life); 2) Domain-Specific Impact (the measurable deterioration in the caregiver’s physical, emotional, social, and spiritual health); 3) Specific Concerns (quantifying worries about health, suffering, and recovery for all family members); and 4) Readiness to Change (the motivational stage for adopting self-care behaviors or pursuing professional help, based on the Transtheoretical Model of Change).

These instruments inherently recognize that concurrent disorders are a systemic family issue, not just an individual one. By focusing on the caregiver’s suffering, resentment, guilt, and reduced quality of life, they operationalize the concept of secondary trauma and chronic stress associated with severe, complex mental health and substance use challenges.

Validity

While the provided source material is an excerpt from a toolkit rather than a psychometric journal, the face validity and content validity of the scales appear high. The items directly reflect known stressors and emotional responses reported by families dealing with chronic mental illness and addiction, such as anxiety, isolation, physical neglect, and resentment. The structure of the Family Concurrent Disorders Index of Concerns Quiz demonstrates strong content validity by systematically assessing impact across three targets (the ill member, other family members, and self) and four major domains (health/wellbeing, suffering, ability to cope, and specific supports).

Further psychometric validation, including construct validity through correlation with established measures of burden (e.g., the Zarit Burden Interview) and convergent validity with measures of depression or generalized anxiety disorder in caregivers, would typically be required for clinical research use, but the utility within a psychoeducational or therapeutic context is evident based on the comprehensive item selection.

Reliability

Specific internal consistency reliability coefficients (such as Cronbach’s alpha) are not detailed in the source material, which is characteristic of instruments designed primarily for immediate clinical or educational use rather than rigorous academic research publication. However, the structured, multi-item format of the Preoccupation and Impact Scale suggests an intent toward internal consistency, grouping items that measure similar concepts (e.g., preoccupation, anxiety, and social isolation).

For therapeutic purposes, the test-retest reliability is important for tracking progress. The Readiness to Change Ruler, in particular, is designed to be highly sensitive to changes in motivational state over time, serving as a reliable indicator of movement along the stages of change during family intervention.

Factor Analysis

Formal factor analysis results are not provided in the source documentation. However, based on the structure of the scales, several latent factors are implicitly targeted:

1. Preoccupation and Loss of Self: Items on the PIS likely load onto a factor representing the absorption of the caregiver’s identity and routine into the relative’s illness.

2. Negative Emotional and Physical Outcomes: Items detailing anxiety, sadness, physical health decline, and anger would form a factor related to somatic and emotional consequences of stress.

3. Systemic Family Concern: Items on the FCDIC are explicitly designed to load onto factors differentiating concern for the ill individual, concern for other family members, and concern for the self, across specific areas like financial or spiritual health.

Instrument

Test Type: Self-report battery (comprising a qualitative log, two Likert/rating scales, and a motivational ruler).

Format: Paper-and-pencil or interview-administered questionnaires and logs.

Language Available: English (as presented in the source documentation).

Population Group: Family members or significant others providing care for an individual with concurrent disorders.

Age Group: Adults (caregivers).

Population Details: Caregivers dealing specifically with the complexity of co-occurring mental health and substance use issues, often requiring engagement with psychiatric wards, emergency rooms, and addiction services.

Test Methodology: Utilizes multiple scaling methods: 1) Qualitative self-reflection (Personal Impact Log); 2) 5-point Likert scale (Preoccupation and Impact Scale); 3) 11-point Concern Rating (Family Concurrent Disorders Index of Concerns Quiz); and 4) 11-point Motivational Ruler (Readiness to Change Ruler).

Keywords

Caregiver stress, family intervention, addiction, mental illness, coping mechanisms, self-care, dual diagnosis, burden assessment, psychological instrument, support group utilization.

Authors

Author ORCID Identifier: N/A (Information not provided in source.)

Affiliation Email addresses: N/A (Information not provided in source.)

Correspondence Address: Centre for Addiction and Mental Health (CAMH), Canada (Affiliation based on source documentation).

Permissions & Fee and Test Year

The instruments were published as part of educational and clinical resources, notably the 2007 “A Family Guide to Concurrent Disorders” by O’Grady & Skinner, produced by the Centre for Addiction and Mental Health (CAMH). They appear to be freely available for clinical and educational use within the context of family support programs, as they are included in freely downloadable guides and toolkits. The original PDF providing access to this instrument set, the EDAS Family Focus Toolkit, can be downloaded here: http://nceta.flinders.edu.au/files/6513/0948/1146/EDAS_Family%20Focus%20Toolkit.pdf.

Reference’s

• O’Grady, C.P. & Skinner, W.J., (2007), A Family Guide to Concurrent Disorders, Centre for Addiction and Mental Health (CAMH).

• Kashner, T.M., Rader, L.E., Rodell, D.E., et al, (1991). Family characteristics, substance abuse, and hospitalization patterns of patients with schizophrenia, Hospital and Community Psychiatry 42, 195-196.

• Centre for Addiction and Mental Health (CAMH). A Family Guide to Concurrent Disorders. Available at: A Family Guide to Concurrent Disorders PDF.

Items of the How Concurrent Disorders Affect Family Life

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. PERSONAL IMPACT LOG (Example)

An example of a personal impact log:

Physical Health

• Chest pain has returned – too worries about my son
• No time to go to my own doctor anymore
• No longer exercising
• Always tired
• Can’t sleep without talking sleeping medication (never used to need anything to sleep)
• Joint stiffness and neck pain
• Eat high-sugar foods‚ don’t care about my diet anymore

Emotional Health

• Constant worrying about my son
• Worrying about everything now
• Bad anxiety and sadness
• I’m always angry or frustrated or depressed these days
• I snap at my other children and then feel guilty
• I’m angry with my husband – he gets to leave for work all day and leaves me to deal with all of our problems

Social Life

• Never go out with husband or close friends anymore
• Never have guests over for dinner
• Can’t concentrate on reading
• Spend all of our time in emergency rooms or visiting our son on psychiatric wards

Spiritual Life

• Don’t know what this is anymore!
• Don’t go to church
• No time for my daily meditation readings
• Don’t feel like doing my yoga sessions anymore
• Bitter and resentful about my son’s illness – why my family?

2. The Preoccupation and Impact Scale

How strongly do you agree or disagree with these statements?

Strongly Agree‚ Agree‚ Disagree‚ Strongly Disagree‚ Don’t Know

• I can’t stop worrying about my family member’s illness.
• I am able to maintain a healthy balance in my life.
• I have trouble thinking about anything other than my family member’s mental illness and substance use problems.
• I feel that I’m completely preoccupied with my family member’s mental illness and substance use problems.
• My daily routine completely centres on my family member’s illness.
• I find myself a lot more anxious these days.
• I make sure I find time to do things for myself and to have fun.
• I never feel that I am doing enough for my ill family member.
• Sometimes I feel that I am drowning in my family member’s illness.
• I focus so my on my ill relative’s problems that I have difficulty finding time to spend on other members of my family.
• I have very little time and energy to socialise with my friends.
• My physical health (eg. nutrition‚ sleep and rest) has been negatively affected since I’ve been dealing with my family member’s mental health and substance use problems.
• I have had a hard time gaining a sense of emotional well-being since my family member developed mental illness and substance use problems.
• I am able to cope with my loved one’s mental illness and substance use problems.
• I think it is OK for family members to feel angry with‚ or resentful of‚ their ill loved one.

3. The Family Concurrent Disorders Index of Concerns Quiz

Not Concerned 0__________________ 10 Very Concerned

How concerned am I about…

• The immediate overall health and wellbeing of my ill family member?
• The immediate overall health and wellbeing of the other members of my family?
• My own immediate overall health and wellbeing?
• The long term overall health and wellbeing of my ill family member?
• The long term overall health and wellbeing of other members of my family?
• My own long term overall health and wellbeing?
• How much my ill family member is suffering?
• How much the other members of my family are suffering?
• How much I am suffering?
• My ill family member’s ability to get through this?
• The ability of my other family members to get through this?
• My own ability to get through this?
• The emotional health of my ill family member?
• The emotional health of other members of my family?
• My own emotional health?
• Whether my ill family member is getting enough social support?
• Whether the other members of my family are getting enough social support?
• Whether I am getting enough social support?
• My ill family member’s physical health?
• The physical health of the other members of my family?
• My own physical health?
• The spiritual health of my ill family member?
• The spiritual health of the other members of my family?
• My own spiritual health?
• My ill family member’s financial situation?
• The financial situation of the other members of my family?
• My own financial situation?
• My ill family member’s journey of recovery?
• The recovery journey of the other members of my family?
• My own journey of recovery?

The Family Concurrent Disorders: Readiness to Change Ruler

Completing this tool may help you to think about how ready you are to change certain beliefs and actions associated with ha‎ving a loved one with concurrent disorders.

Using the ruler shown below‚ indicate how ready you are to make a change in each of the following areas. If you are not at all ready to make a change‚ you would circle the 1. If you are already trying hard to make a change‚ you would circle the 11. If you are unsure whether you want to make a change‚ your would circle 3‚ 4 or 5. If a particular item does not apply to you‚ circle “Does Not Apply” in the box to the right.

How ready am I to … ?

• . . . admit that my family member has both a mental health and a substance use problem?
• . . . accept that my family member has both a mental health and a substance use problem?
• . . . accept that I am not to blame for my family member’s concurrent disorders?
• . . . think about ways I can best help my family member?
• . . . seek help for my family member from mental health and/or addiction professionals?
• . . . seek help for myself from mental health and/or addiction professionals?
• . . . seek help for my family member from a self-help group (e.g.‚ AA‚ Dual Recovery)?
• . . . seek help for myself from a family peer support group (e.g. Al-Anon‚ Mood Disorders Association of Ontario)?
• . . . seek help for my family member or for myself in spite of the stigma associated with concurrent disorders?
• . . . work on overcoming any other barriers preventing me from attending a professional or self-help family intervention?
• . . . commit to taking care of myself as a top priority?
• . . . admit to and accept my own personal strengths and limitations?
• . . . accept that relapses are common in recovery from concurrent disorders?