Abstract
PurposeAddiction is a major health stressor for families, representing an under-researched area with important policy implications. The current aim was to validate the Composite Codependency Scale, which captures the psychological characteristics of affected family members, and assess quality of life as mediated by family functioning.MethodsClose relatives (n = 271) of patients in treatment for substance use disorder (SUD) participated in a 4-day psychoeducational program. We also recruited a general population sample (n = 393) via an online social media site. Data were analyzed using multigroup confirmatory factor analysis (MGCFA) and a latent regression model. Differences in subscale latent means were applied to ascertain how the scale discriminated the two populations.ResultsMGCFA yielded a shortened, nine-item partial scalar invariant scale (SCCS) that allowed comparison of latent means. The SCCS discriminated between family members and the general population, with family scoring higher on all three scale dimensions. By effect size, family had higher means (mean differences; 95% confidence intervals) for ‘emotional suppression’ (0.48; 0.36–0.59; p < 0.001; effect size, 0.92), ‘interpersonal control’ (0.47; 0.36–0.59; p < 0.001; effect size, 0.97), and ‘self-sacrifice’ (0.20; 0.10–0.29; p < 0.001; effect size, 0.43). Higher SCCS scores were associated with greater family dysfunction (β = 1.00, 95% CI 0.63–1.36; p < 0.001) and worse quality of life (β = − 0.23, 95% CI − 0.30 to − 0.16; p < 0.001), confirming the concurrent validity of the SCCS.ConclusionWhen family members of people with addictions had the psychological characteristics of suppressing their emotions, believing they could fix others’ problems, and neglecting their own for others’ needs, they also had more family dysfunction and poorer quality of life. The SCCS offers a valid instrument for addressing the life situation of affected families. This scale can help clinicians focus on family members within health services, especially within SUD treatment services.
Highlights
Addiction in a family member is a major health stressor and seriously affects an estimated 100 million people worldwide [1]
The scale first had to be tested for measurement equivalence across groups, so we focused on the sub-dimensions of the Codependency Scale (CCS) to examine how family members differed from the general population
Our findings indicate that the shortened Shortened Composite Codependency Scale (SCCS) is a promising measure in this area of research on family members of people with addiction or other harmful substance use
Summary
Addiction in a family member is a major health stressor and seriously affects an estimated 100 million people worldwide [1]. Family members who experience this stressor have a poorer health status and well-being [2] They are more likely to be diagnosed with substance use, anxiety, and depression disorders themselves and have higher health care costs than family members of persons with other chronic conditions like diabetes or asthma [3, 4]. In addition to the direct impact on family health of a substance use or addiction disorder, family members are at risk of developing distinctive psychological characteristics that leave them vulnerable to other health problems. Given the large scale of the addiction problem and obvious relevance to public health of these experiences of family members, these underlying characteristics and their association with health and well-being require examination. Such efforts would potentially pave the way for family members to be invited more systematically to participate in treatment of patients with SUDs and to gain access to help for themselves [1]
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