Family Member Impact Questionnaire (FMI)

Abstract

The Family Member Impact Questionnaire (FMI) is a standardized psychological instrument designed to assess the degree of burden and specific types of disruption experienced by family members living with a relative who has problems related to substance use disorder, including alcohol, drugs, or gambling. Developed initially by Orford and colleagues in 1976, and subsequently refined in 1999 and 2005, the FMI measures the practical, emotional, social, and financial consequences faced by significant others. The scale is a critical component of the broader framework used to assess stress, coping, and strain among relatives affected by addiction, providing quantitative data on the negative impact of the relative’s problematic behaviors.

Keywords

Family Member Impact Questionnaire, FMI, addiction, family burden, strain, coping, alcohol use disorder, drug use, psychological assessment, Orford.

Authors

Orford, J., Oppenheimer, E., Egert, S., Hensman, C., Guthrie, S. (1976); subsequent revisions by Orford, J., Velleman, R., Templeton, L., Copello, A. (1999, 2005).

Purpose

The primary purpose of the FMI is to quantify the specific behavioral and psychological impacts stemming from a family member’s substance or addiction issues. By detailing 16 areas of life disruption, the questionnaire provides a clear, measurable index of the burden experienced by the respondent. This information is crucial for clinical settings, allowing therapists to tailor interventions to mitigate the negative consequences and improve the coping mechanisms of the affected relative. Furthermore, the FMI serves as a vital research tool for studying the epidemiology and outcomes related to family resilience and strain in the context of addiction.

The scale aids in differentiating between various forms of family distress, specifically separating general worry from observable, immediate disturbances caused by the relative’s behavior. The results are often used to evaluate the effectiveness of family support programs and interventions designed to alleviate family strain resulting from substance use disorder.

Construct

The FMI measures the psychological construct of Family Impact or Family Burden, specifically defined as the observable and perceived adverse consequences experienced by relatives due to the problematic behavior associated with a family member’s addiction. This construct is multidimensional, encompassing emotional distress, social isolation, financial instability, and direct interpersonal conflict.

The scale is structured around two key factors that contribute to the overall Total Impact score: Worrying Behavior and Active Disturbance. Worrying Behavior relates to internal concerns and passive consequences (e.g., health worries, neglect of self-care, financial strain), while Active Disturbance relates to overt, confrontational, or socially disruptive behaviors caused by the relative (e.g., quarrels, changeable moods, threats). This distinction allows for a nuanced understanding of how the addiction manifests within the family system.

Validity

The validity of the FMI has been established through its extensive use in clinical and research settings focused on addiction. The instrument demonstrates strong content validity, as its items were derived from detailed qualitative research and clinical observations regarding the experiences of family members affected by substance abuse. The items comprehensively cover the spectrum of typical problems reported, ranging from financial issues and social disruption to emotional volatility and physical health concerns.

Furthermore, studies investigating the FMI’s structure (especially the 2005 standardization) support its construct validity, showing that the subscales correlate logically with other established measures of stress, strain, and coping. For instance, high FMI scores are predictably associated with higher levels of psychological distress and lower levels of family cohesion, reinforcing that the scale accurately measures the intended construct of family burden related to substance use disorder.

Reliability

The FMI exhibits good to excellent reliability, particularly in its standardized 16-item version. Internal consistency, typically measured using Cronbach’s alpha, has been reported consistently high for the Total Impact score, often exceeding 0.85, indicating that the items cohere well as a measure of overall burden. The individual subscales, Worrying Behavior and Active Disturbance, also generally demonstrate acceptable levels of internal consistency, though sometimes lower than the total score, which is typical for shorter subscales.

Test-retest reliability, which assesses the stability of the measure over time, is generally high, suggesting that the FMI provides stable assessments of family impact unless there has been a significant change in the relative’s addictive behavior or the family environment. These strong psychometrics confirm the FMI’s utility as a reliable tool for both cross-sectional and longitudinal research.

Factor Analysis

The underlying structure of the FMI has been rigorously investigated using factor analysis, particularly during the standardization efforts led by Orford and colleagues in 2005. Early versions suggested a complex structure, but the refined 16-item FMI consistently supports a two-factor solution, which aligns with the theoretical distinction between internal worry and external disturbance. This factor analysis confirmed the empirical distinction between the two subscales:

• Factor 1: Worrying Behavior. This factor captures items related to the relative’s potential harm to themselves (health, work, self-care) and general unreliability or low-level strain that the family member internalizes.
• Factor 2: Active Disturbance. This factor captures items related to direct interpersonal conflict, aggression, and overt social disruptions caused by the relative’s behavior.

The identification of these distinct factors provides researchers and clinicians with a more granular understanding of the specific dimensions of family burden being experienced.

Instrument

Test Type: Self-report questionnaire / Psychological scale

Format: 16 items utilizing a 4-point Likert-style frequency rating scale (0 to 3), plus a “Don’t know” option handled separately for scoring.

Language Available: Primarily English; adaptations may exist in other European languages given its international use in addiction research.

Population Group: Family members, spouses, partners, or significant others of individuals with alcohol, drug, or gambling problems.

Age Group: Adults (typically 18+), capable of responding to self-report questions regarding their experiences.

Population Details: Respondents are required to be living with or significantly affected by the behavior of a relative experiencing an addiction or severe problematic substance use.

Test Methodology: The questionnaire is administered to the family member. Scores are summed to calculate the Total Impact score (range 0–48) and two distinct subscale scores (Worrying Behavior and Active Disturbance). A rule is applied regarding “Don’t know” responses: if more than three items are marked “Don’t know,” the questionnaire should not be scored.

Keywords

Family burden, substance abuse consequences, psychological distress, strain, clinical assessment, psychometrics, Jim Orford, Alcohol, Drugs, Gambling and Addiction Research Group.

Authors

Author ORCID Identifier: Not uniformly available or provided in the source material for all authors.

Affiliation Email addresses: Contact information is typically held by the current copyright holders.

Correspondence Address: Alcohol, Drugs, Gambling and Addiction Research Group, School of Psychology, The University of Birmingham, UK (as of 2005).

Permissions & Fee and Test Year

The instrument was first published in 1976 and standardized in its current 16-item form in 2005. The scale is often utilized freely for non-commercial academic research, though formal permission should be sought from the copyright holders: Alcohol, Drugs, Gambling and Addiction Research Group, School of Psychology, The University of Birmingham. The scale is sometimes included as part of larger assessment protocols for which usage terms may vary.

The FMI instrument can be found in documentation available online. The original document link provided in the source is: http://nceta.flinders.edu.au/files/3013/0948/1376/assessment%20tools%20stress%20strain%20support.doc (Note: This is a direct link to a DOC file containing assessment tools, including the FMI.)

Reference’s

The development and standardization of the FMI are detailed across several key publications:

• Orford, J., Oppenheimer, E., Egert, S., Hensman, C. & Guthrie, S. (1976). The cohesiveness of alcoholism-complicated marriages and it’s influences on treatment outcome. British Journal of Psychiatry, 128, 318-339.
• Velleman, R. & Orford, J. (1999) Risk and Resilience: Adults Who Were the Children of Problem Drinkers. Reading: Harwood.
• 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.
• Orford, J., Templeton, L., Velleman, R., & Copello, A. (2010). Methods of assessment for affected family members. Drugs: education, prevention and policy, 17(S1). doi: 10.3109/09687637.2010.514783
• Orford, J. (2014). Testing the short questionnaire for family members affected by addiction: help required. At: http://www.afinetwork.info/research-articles/371-testing-the-short-questionnaire-for-family-members-affected-by-addiction-help-required

Items of the Family Member Impact Questionnaire (FMI)

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

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?
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?

SCORING INSTRUCTIONS:

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 Behavior, sum items 3, 4, 8, 9, 11, 12, 13, 14, 15, 16

FOR Active Disturbance, sum items 1, 2, 5, 6, 7, 10