Family Member Impact Questionnaire (FMI)

Abstract

The Family Member Impact Questionnaire (FMI) is a brief, 16-item psychological scale designed to measure the specific negative consequences and strain experienced by family members due to a relative’s problem behavior, typically associated with addiction or severe problem drinking/drug use. It provides quantifiable scores across a Total Impact dimension and two distinct subscales: Active Disturbance and Worrying Behavior. The FMI is a core component of a standardized battery of questionnaires developed by Orford and colleagues to comprehensively assess stress, coping, and strain within families affected by substance use disorders.

Keywords

Family Member Impact Questionnaire, FMI, family strain, family burden, addiction, substance use disorder, problem drinking, psychological assessment, Orford, active disturbance, worrying behavior.

Authors

Orford, J., Velleman, R., Templeton, L., Copello, A., Oppenheimer, E., Egert, S., Hensman, C., Guthrie, S.

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Purpose

The primary purpose of the FMI is to provide a standardized, quantifiable measure of the immediate and tangible impact that a relative’s problematic behavior—particularly substance use, drug use, or gambling—has on the family unit and the individual family member completing the questionnaire. This instrument helps clinicians and researchers gauge the level of distress and disruption caused by the relative’s actions across various domains, including emotional, financial, social, and behavioral areas.

By differentiating the types of impact into subscales, the FMI allows for a nuanced assessment, which is critical for tailoring support interventions. It moves beyond general stress metrics to specifically map the behavioral outcomes of the relative’s substance use disorder onto the family’s daily life and psychological well-being.

Construct

The primary construct measured is the level of strain or burden experienced by family members (often referred to as ‘affected others’). This burden is conceptualized as multi-dimensional, reflecting both direct conflict and passive concern related to the relative’s behavior.

The FMI measures two specific dimensions of impact:

• Active Disturbance: Items related to direct, confrontational, or disruptive behaviors by the relative (e.g., changeable moods, picking quarrels, threats, upsetting family occasions).
• Worrying Behavior: Items reflecting concern over the relative’s personal deterioration, financial problems, unreliability, and the impact of their substance use on their health, work, or self-care.

Validity

The FMI has demonstrated strong conceptual and empirical validity. Its items are derived from extensive qualitative research into the experiences of family members affected by addiction, ensuring high content validity. Published studies, such as those by Orford, Templeton, Velleman, and Copello (2005, 2010), confirm the scale’s ability to discriminate between different levels of family strain.

Concurrent validity is established through correlations with other standardized measures of psychological distress, general family strain, and coping mechanisms. The specific delineation of items into ‘Active Disturbance’ and ‘Worrying Behavior’ subscales provides evidence of construct validity, showing that these two facets of family impact are distinct yet related dimensions of the overall burden.

Reliability

Studies confirm the reliability of the FMI, demonstrating strong internal consistency across the total scale and its subscales. Internal consistency, typically measured using Cronbach’s Alpha, is reported to be robust, indicating that the items within each subscale consistently measure the intended construct. This reliability ensures that the measure provides stable and consistent results when used in clinical assessment or research settings.

Factor Analysis

The scale’s structure, derived through factor analysis, clearly delineates two primary dimensions of impact. This statistical process confirmed that the 16 items cluster into the two theoretically distinct subscales—Active Disturbance and Worrying Behavior—which contribute significantly to the overall Total Impact score. This factor structure provides empirical support for the scale’s scoring protocol and its utility in separating different modes of family strain.

Instrument

Test Type: Self-report questionnaire (Psychological scale)

Format: 16 Likert-style items. Responses are scored on a 0–3 scale (Not at all=0, Once or twice=1, Sometimes=2, Often=3). Specific items (3, 6, 7) have special scoring for “Don’t know” responses (scored as 1), while all other items score “Don’t know” as 2. If more than three “Don’t know” responses are recorded, the questionnaire should not be scored.

Language Available: English (Primary language of development).

Population Group: Family members, partners, or significant others of individuals exhibiting problematic behaviors (primarily substance use, drug use, or gambling).

Age Group: Adults (or adolescents capable of understanding the items and relationship dynamics).

Population Details: Individuals who are in close contact with a relative whose addiction or problem behavior is causing demonstrable strain on the family system.

Test Methodology: Pencil-and-paper or digital administration. Scoring involves summing item scores to achieve a Total Impact score, an Active Disturbance subscore, and a Worrying Behavior subscore.

Keywords

Psychometric scale, family assessment, addiction research, coping, strain measurement, Orford scale, self-report, psychological burden, problematic substance use.

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Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: Correspondence typically directed to the Alcohol, Drugs, Gambling and Addiction Research Group, School of Psychology, The University of Birmingham.

Correspondence Address: School of Psychology, The University of Birmingham, UK.

Permissions & Fee and Test Year

The instrument was developed and copyrighted by the Alcohol, Drugs, Gambling and Addiction Research Group, School of Psychology, The University of Birmingham. While the foundational work on family impact dates back to 1976 (Orford et al.), the specific standardized set of questionnaires including the FMI was formalized and published around 2005.

The instrument is often made available for non-commercial research purposes. Users should seek formal permission from the copyright holders prior to implementation. The original DOC file containing the instrument can be downloaded here: http://nceta.flinders.edu.au/files/3013/0948/1376/assessment%20tools%20stress%20strain%20support.doc

Reference’s

• 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

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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:

Responses are typically scored: Not at all=0, Once or twice=1, Sometimes=2, Often=3.

If “Don’t know” is selected, items 3, 6, 7 are scored as 1, and all other items are scored as 2. If there are more than 3 “Don’t know” responses in total, the questionnaire should not be scored.

Subscale Calculation:

• FOR Total Impact: Sum all items (1–16).
• 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.