Development of Forman Scale for Codependency Measure Among Wives of Men with Substance Use Disorders in Pakistan

Background: Codependency among wives of men with substance use disorders (SUDs) remains under-examined in non-Western, patriarchal contexts where gender roles and cultural expectations shape relational behavior. In societies such as Pakistan, norms surrounding marital loyalty, family honor, and emotional restraint may intensify gendered expressions of codependency. Objective: The present study aimed to develop and validate a culturally grounded Urdu-language instrument the Forman Scale for Codependency of Spouses of Substance Abusers (FSCSSA) designed to capture gendered and culturally embedded manifestations of codependency among Pakistani wives of men with SUDs. Methods: A sequential exploratory mixed-methods design was employed. Semi-structured interviews (N = 20) informed item generation, followed by expert review and pilot testing. The refined scale was administered to 170 married women recruited from rehabilitation centers and NGOs in Lahore, Pakistan, who had lived with a husband diagnosed with SUD for at least one year. Exploratory factor analysis (EFA) using principal component analysis with Varimax rotation was conducted (KMO = 0.83; Bartlett's p < .001). Results: A 49-item scale was retained, explaining 45.4% of the total variance. Five factors emerged: Control and Compliance, Low Self-Worth, Self-Sacrifice, Suppression of Emotions, and Conflicting Relationship. Internal consistency was strong across subscales (α = .73-.88), with excellent reliability for the total scale (α = .93). Conclusions: The FSCSSA is a psychometrically sound and culturally responsive measure of codependency among wives of men with SUDs in Pakistan. By integrating gender norms and socio-cultural expectations into its conceptual framework, the scale advances culturally sensitive assessment of relational dynamics in addiction-affected families.