EXPLORATORY AND CONFIRMATORY

FACTOR ANALYSES OF THE

BRIEF SYMPTOM INVENTORY AMONG
SUBSTANCE ABUSERS

LOIS A. BENISHEK*

Temple University
CATHERINE M. HAYES

Ball State University

KATHLEEN J. BIESCHKE

Pennsylvania State University

BERTRAM E. STOFFELMAYR

Michigan State University

ABSTRACT: The Brief Symptom Inventory (BSI) is a multidimensional measure of
psychological and somatic distress that is used to obtain detailed symptom profiles. The
BSI has been questioned regarding its ability to differentiate among its proposed nine
dimensions, and the factor structure underlying the BSI has not been confirmed with
substance abusers. Exploratory factor analyses were completed on substance abusers
(ntota I = 453; nwomen = 121; ninen = 332); nine factors were not identified. Five models
were then submitted to confirmatory factor analyses using an independent sample of
substance abusers (ntota l = 456; nwomen = 127; ninen = 329). A one-factor model (i.e.,
global psychological distress) best represented the data. Implications for using the BSI
in research and counseling are discussed.

*Direct all correspondence to: Lois A. Benishek; Counseling Psychology Program; 270-B Weiss Hall (265-63);
1701 N. 13th Street; Temple University; Philadelphia, PA 19122-6085 < lbenishek@aol.com>.
JOURNAL OF SUBSTANCE ABUSE, Volume 10, pages 103-114.
Copyright 1998 by Ablex Publishing Corporation
All rights of reproduction in any form reserved.
ISSN: 0899-3289

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Multidimensional self-report measures have become a popular and efficient method of

assessing psychological symptoms among a variety of clinical populations. These assessment tools are appealing because they are less labor-intensive and, thus, more cost effective than clinical interviews. They often offer broad spectrum descriptions of individuals,
identify specific problem areas, and provide a framework for matching clients to specific
treatment modalities and interventions (Alterman, McLellan, and Shifman., 1993; Donat,
1988; Loza, 1993; Pfost, Newton, Kunce, Greenwood, and Cope, 1993).
The use of multidimensional assessment tools is also being encouraged in the field of
substance abuse (e.g., James, Moore, and Hastings, 1995). Specifically, the Symptom
Checklist-90-R (SCL-90-R) has been recommended for use in place of more specific
measures of psychopathology with substance abusers (Moffett and Radenhausen, 1990). A
review of the literature, however, indicates that this recommendation may be premature.
Questions about the actual factor structure underlying the SCL-90-R began to emerge as
early as the 1980's with research findings casting doubt on the ability of the SCL-90-R and
its derivatives to assess the nine proposed psychological dimensions.
The authors will not differentiate between the versions of the SCL-90 used in the various
studies reviewed. (The label "SCL-90-R" will be used throughout this article. Readers
should consult each publication in order to identify the specific version used in that particular study.) One review of the factor analytic research on the SCL-90-R identified
anywhere from four to twelve factors across a variety of inpatient and outpatient populations (Cyr, McKenna-Foley, and Peacock, 1985). Factor analyses completed on the
SCL-90-R since Cyr's review also fall to support the original nine-factor structure (e.g.,
Bech, Allerup, Maier, Albus, Lavori, and Ayuso, 1992; Brophy, Norvell, and Kiluk, 1988;
Carpenter and Hittner, 1995; Hafkensheid, 1993; Rauter, Leonard, and Swett, 1996;
Schwarzwald, Weisenberg, and Solomon, 1991; Shutty, DeGood, and Schwartz, 1986;
Steer, Clark, and Rnier, 1994).
Many of these studies consistently reveal high correlations among the nine subscales of
the SCL-90-R (Cyr et al., 1985). Furthermore, the first factor consistently explains over
half of the variance accounted for (Brophy et al., 1988; Clark and Friedman, 1983; Cyr et
al., 1995; Evenson, Holland, Mehta, and Yasin, 1980). Taken as a whole, these findings
suggest that the SCL-90-R may be an indicator of global distress rather than a multidimensional measure of psychopathology.
There are two notable details about these studies on the SCL-90-R. First, only one study
has been completed on a substance abusing population (Carpenter and Hittner, 1995).
Second, with few exceptions (Carpenter and Hittner, 1995; Hafkensheid, 1993; Hayes,
1997; Strauman and Wetzler, 1992; Shutty et al., 1986), the results of these studies were
derived from exploratory rather than from more powerful confirmatory factor analytic
procedures.
Little attention has been given to the factor structure underlying the Brief Symptom
Inventory (BSI), a shorter, more recent derivative of the SCL-90-R. Similar to the
SCL-90-R, the BSI has been used by both researchers and clinicians to assess psychological symptoms in general clinical populations (e.g., Carscaddon, 1990; Hayes, 1997;
Piersma, 1994a; 1994b) as well as substance abusing populations (e.g., Harvey, 1994;
O'Connor, 1995).
There is reason to believe that the concerns raised about the SCL-90-R also apply to the
BSI since the BSI is "essentially a brief form of the SCL-90-R" with the items "selected to

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105

reflect best the nine primary symptom dimensions" (Derogatis and Melisaratos, 1983; p.
596). Furthermore, the identical scales between the two questionnaires correlate .92 or
greater (Derogatis and Melisaratos, 1983).
To date, only three principal components factor analyses and one confirmatory factor
analysis have been completed on the BSI. The seminal investigation was completed by
Derogatis with the data for these analyses obtained from a general outpatient clinical
sample (N =1,002; Derogatis and Melisaratos, 1983; Derogatis and Spencer, 1982). Overall, this analysis produced results that clearly replicated seven of the nine expected factors.
The last two factors were not reproduced as consistently as the first seven. The eighth
factor (i.e., anxiety) split into panic anxiety and nervous tension components. Overall, the
ninth factor showed poor psychometric properties and was in need of further revision. The
nine factors accounted for 44% of the explained variance.
These results were not replicated in the two subsequent principal components analysis
and the confirmatory factor analysis completed on the BSI. Only two factors emerged from
the analysis completed by Boulet and Boss (1991), accounting for 71% and 5.9% of the
explained variance, respectively. Only 29 of the 49 items correlated as expected with their
hypothesized scales. Furthermore, the dimensions were highly correlated with each other
(range = .55 to .80). More recently, a single factor was identified by Piersma (1994b).
Results from the confirmatory factor analysis conducted by Hayes (1997) on a sample of
treatment-seeking college and university students resulted in the identification of a
six-factor solution.
How does one make sense of the great variation in the number of factors identified from
the SCL-90-R and the BSI, and what are the implications for the BSI? One possible explanation is that these instruments are simply deficient in their ability to assess the nine
hypothesized factors. An alternative explanation is that the discrepancies of the factor
structure may be a result of sample differences. The SCL-90 was developed on a psychiatric outpatient sample, and its nine-factor structure has not been identified consistently
across a variety of clinical populations. For example, four-, six-, nine-, and twelve-factor
solutions were identified among a variety of inpatient and outpatient populations (Brophy
et al., 1988; Evenson et al., 1986; Hafkensheid, 1993). These findings lend credence to the
idea that different clusters of symptoms may be expressed in different treatment populations (Hafkensheid, 1993; Schwarzwald et al., 1991). They also support the importance of
examining further the factor structure among more homogeneous inpatient and outpatient
populations (Holcomb et al., 1983; Shutty et al., 1986).
In conclusion, serious questions are being raised about the proposed nine dimensions of
the BSI and the SCL-90-R by a number of independent researchers. As stated previously,
the BSI represents a short form of the SCL-90-R, an instrument which has not demonstrated factor invariance (e.g., Cyr et al., 1985). Further, a different measurement model for
the SCL-90-R was demonstrated for substance abusers (Carpenter and Hittner, 1995).
Little evidence exists for the BSI's factor structure in general and no study has specifically
focused on the BSI's factor structure for substance abusers. The purpose of this study was
to examine the psychometric properties of the BSI and to attempt to confirm its factor
structure on data derived from a large sample of substance abusers.
The factor structure of the BSI was examined in the following fashion. First, the coefficient alpha estimates and interscale correlations were examined to evaluate the internal
consistency reliability of each scale and identify problematic items. Second, principal axis

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factor analyses (PAF) were completed to explore the underlying factor structure and to
generate alternative models. Third, these alternative models along with two nine-factor
models (one with uncorrelated factors and one with correlated factors) were then submitted
to confirmatory factor analyses. The confirmatory factor analyses were completed on data
derived from a second, independent sample of substance abusers.

METHOD
Participants
Participants consisted of 909 adult clients (73% men; 27% women) receiving substance
abuse treatment. The average age of the participants was 31 years. Fifty-three percent of
the sample were white, 44% were black, and 3% represented other ethnic backgrounds.
Thirty percent had less than a high school education (M = 11.8 years). Approximately half
of the sample (53%) were employed full-time, 17% part-time, and 22% were unemployed;
other participants identified themselves as retired (2%) or as students (3%). With regard to
treatment relevant characteristics, 50% of the participants entered outpatient treatment
programs, whereas 7% received 30-day residential treatment and 43% received treatment
at residential programs lasting longer than 30 days. The substance identified as the major
problem for participants was a combination of alcohol and drugs (41%), alcohol (30%),
cocaine (17%), a combination of drugs (7%), cannabis (3%), and other drugs (2%). This
was the first substance abuse treatment experience for 57% and 60% of the participants
requesting treatment for alcohol use and drug use, respectively. Treatment was prompted
by the criminal justice system for 38% of the sample; 36% were on probation or parole at
the time of the assessment. Participants reported significant periods of time in the 30 days
prior to treatment in which they experienced serious depression, anxiety/tension, and
violent behavior (46%, 49%, and 14% of the participants, respectively).

Procedures
Participants were contacted at the time they requested services at a substance abuse
treatment program and asked to participate in the study. Efforts were made to ensure that
data were collected after the initial request for services and prior to completing the initial
counseling session. The study was explained to participants and informed consent was
obtained during this meeting. Individuals who were less than 18 years of age were
excluded from the study.
A battery of questionnaires and interviews designed to provide a broad-based picture of
life and psychological functioning was completed by each participant. Only information
obtained from the Brief Symptom Inventory (BSI) and demographic information is
presented here. Participants were paid $10.00 for completing the assessment battery.

Measures
BRIEF SYMPTOM INVENTORY
The Brief Symptom Inventory (BSI) is a multi-dimensional self-report measure of
psychological distress (Derogatis and Melisaratos, 1983). The 53-item questionnaire is

Brief Sympton Inventory

107

answered using a five-point Likert scale (0 = Not at all; 4 = Extremely) with regard to the
individual's psychological functioning in the past seven days. Higher scores indicate
greater psychological distress.
The BSI is designed to assess nine types of psychopathology. Forty-nine of the items are
hypothesized to measure one of the following dimensions: somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, anxiety, hostility, phobic
anxiety, paranoid ideation, and psychoticism. Four additional items correlate highly on
more than one factor and, thus, are included in the measure (Derogatis and Spencer, 1982).
The correlations of the BSI dimensions with like dimensions contained in its parent instrument, the SCL-90-R, range from .92 to .99 (Derogatis and Spencer, 1982).
The BSI also yields three global indices of overall psychological functioning. Only the
most sensitive (i.e., accurate) of the three indices, the General Severity Index (GSI; Derogaffs and Spencer, 1982), was used in this study so that the relationship among the 9 BSI
scales could be compared with a global indicator of psychopathology. GSI scores range
from 0 to 4 with higher scores indicating greater severity. The GSI represents a combination of the number of symptoms and their intensity level.
The internal consistency reliability estimates for the subscales range from .70 (phobic
anxiety) to .89 (depression: Boulet and Boss, 1991; Broday and Mason, 1991; Derogatis
and Spencer, 1982). Test-retest reliability estimates range from .68 (somatization) to .91
(phobic anxiety) over a two-week time frame for the nine dimensions and .90 for~the GSI
(Derogatis and Spencer, 1982).

Results
A random split procedure was used to generate the two samples necessary to conduct the
principal axis factor analyses (n I = 440) and the confirmatory factor analyses (n 2 = 456).
The samples did not differ significantly from each other in gender, age, race, religious preference, educational level or with regard to the scores obtained on the nine BSI dimensions
and the GSI.

STUD)" lmPrincipal Axis Factor Analyses

Principal axis factor analyses (PAF: ntotaI = 453; nwornen = 121; nmen = 332) were
completed in order to: (a) better understand the factor structure underlying the BSI, and (b)
generate possible alternative models that could be tested in the confirmatory factor analyses. These analyses were completed using SPSS (Marija J. Norusis/SPSS, Inc., 1990). This
type of exploratory factor analysis is preferred over a principal components factor analysis
when the factors are intercorrelated (Pedhazur and Schmelkin, 1991) and when an underlying factor structure is hypothesized. Results of this analysis were obtained from the
pattern matrix obtained from an oblimin factor rotation. Criteria used to select the substantive factors were: (a) eigenvalues greater than 1.0 and accounting for 3% or more of the
explained variance, (b) the magnitude and number of the item loadings with other factors
(i.e., co-loadings), (c) item loadings > .32, and (d) the conceptual meaningfulness of the
factors (Stevens, 1992; Tabachnik and Fidell, 1996).
The initial results from the PAF produced nine factors with eigenvalues greater than 1.0.
Only two of these factors, however, accounted for 3% or more of the explained variance.
The eigenvalues for these two factors were 19.18 and 1.73; they accounted for 39.1% and

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3.5% of the explained variance, respectively. As a result of these preliminary findings, the
analyses were completed again, this time forcing both a one- and a two-factor solution.
The loadings associated with the one-factor solution ranged from .37 to .75 (M = .58).
This factor accounted for 32% of the explained variance and appeared to be a measure of
global psychological distress.
For the two-factor model, the loadings ranged from .21 to .89 (M = .58) for the first
factor and from .36 to .71 (M - .49) for the second factor. The model accounted for 43% of
the explained variance. Again, the first factor appeared to be assessing global emotional
distress. The second factor, however, consisted mainly of items from the Somatization,
Anxiety, and Phobic Anxiety scales. This factor appeared to be a measure of somatic
distress. The two factors correlated .66 with each other and, thus, accounted for 44% of the
shared variance.
A total of five models were selected to be submitted to confirmatory factor analyses.
Two of these models were explicitly generated from the PAFs. The one-factor model
(Model 1) was retained given the amount of variance explained by this model. The
two-factor model (Model 2) was also selected because of: (a) the presence of only seven
co-loadings between the factors and (b) the conceptual clarity of this model. Given that the
nine sub-scales were so highly correlated with each other, a second-order model (Model 3)
was selected in order to determine if a single higher-order factor was accounting for a
significant amount of the covariances among the first-order factors. Finally, Derogatis's
original nine-dimensional model (i.e., Model 4: assuming uncorrelated factors as the developers initially proposed) and Derogatis's nine-dimensional model (i.e., Model 5: assuming
correlated factors as this data set suggests) were also submitted to a confirmatory factor
analysis.

STUDY2---Confirmatory Factor Analyses

Confirmatory factor analysis (CFA) was conducted on the five models (described above)
using EQS/Windows (Version 4.02; Bentler and Wu, 1993). These analyses were
completed on data obtained from a second, independent sample of substance abusers (ntota1
= 456: nwomen = 127; nmen = 329).
As Table 1 indicates, many of the goodness-of-fit indices suggested that four of the
models fit the data in a relatively similar manner (i.e., Model 1; Model 2; Model 3; Model
5). The results from the PGFI in conjunction with other data, however, identified the
one-factor model as the preferred model (Model 1:X2 = 4157; p < .001). First, the PGFI
values clearly indicated that the one-factor model (PGFI = 0.61) was stronger than Model
2, 3, 4 and 5 which had PGFI values of 0.33, 0.37, 0.33, and 0.19, respectively. The PGFI
is a relatively unbiased measure of fit that adjusts for the degree of parsimony in each
particular model. Second, the factors underlying both Model 2 and Model 5 were highly
correlated (i.e., Model 2: M = .86; Model 5: Range = .47 to .80; M = .67). This high degree
of overlap between the dimensions indicates that the factors were not providing unique
information. Third, with regard to Model 2, the first factor accounted for 39.1% of the
explained variance, whereas the second factor was significantly weaker, explaining only
3.5% of the variance. The factor loadings for the one-factor model are provided in Table 2.
It is important to note that although Model 1 best represented the data, its degree of fit is
less than desirable.

Brief Sympton Inventory

109
TABLE 1

Goodness-of-Fit Indices for Confirmatory Factor Analyses

Mode/

Zz

df

CFI

AGFI

PGFI

AIC

RMR

Null Model

! 4590

1176

--

--

--

13302

--

Model 1
(1 -Factor)

4157

1126

0.77

0,66

0.61

1905

0.06

Model 2
(2-Factor)

3961

1118

0.79

0,68

0.33

1725

0.06

Model 3
(2nd-Order)

3472

1109

0.82

0.72

0.37

1254

0.06

Model 4
(D-orthog)

6915

1118

0.57

0.46

0.33

4679

0.37

Model 5
(D-nonorthog)

3289

1082

0.84

0.73

0.19

1125

0.05

n2 = 456. CFI = Comparative Fit Index; AGFI = Adjusted Goodness-of-Fit Index; PGFI = Parsimonious Goodness-of-Fit Index;
AIC = Akaike Information Criterion; RMR = Root Mean Square Residual. D-orthog = Derogatis's original model assuming
orthogonal dimensions; D- non-orthog = Derogatis's model assuming non-orthogonal dimensions.

TABLE 2

Confirmatory Factor Analysis--One-Factor Model

BSl Items

Original Factor

Factor I Standardized
Factor Loadings

Not given credit for achievements

Feeling lonely
Punished for sins
Blocked in getting things done
Check and double check what you do
Trouble concentrating
Frequent arguments
Feeling lonely with people
Feeling inferior
Easily annoyed or irritated
Feeling blue
No interest in things
Feeling fearful
Feelings easily hurt
Numbness/tingling
Urges to harm another
Something wrong with your mind
Nausea/upset stomach
Avoid things, places because frightening
Feeling weak
Hopeless about future
Urges to break things advantage of you
Feeling people will take
Scared for no reason
Nervous when alone

Par
Dep
Psy
Obs
Obs
Obs
Hos
Psy
Int
Hos
Dep
Dep
Anx
Int
Som
Hos
Psy
Som
Pho
Som
Dep
Hos
Par
Anx
Pho

.79
.77
.76
.74
.74
.73
.73
.72
.72
.71
.71
.70
.70
.70
.70
.70
.70
.69
.69
.69
.69
.68
.67
.64
.64

(continued)

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TABLE 2
Continued

BSl Items
Self-conscious
Nervousness/shakiness
Feeling restless
Trouble remembering
Uneasy in crowds
Not feeling close to others
People can't be trusted
Feeling watched or talked about
Spells of terror or panic
Afraid in open spaces
Hot or cold spells
Trouble getting your breath
Uncontrollable temper outbursts
Thoughts of ending your life
Faintness/dizziness
People are unfriendly or dislike you
Afraid to travel on buses, etc.
Mind goes blank
Feeling worthless
Heart/chest pains
Difficulty making decisions
Others to blame for your troubles
Feeling tense
Others control your thoughts

Original Factor

Factor I Standardized
Factor Loadings

Int
Anx
Anx
Obs
Pho
Psy
Par
Par
Anx
Pho
Sore
Som
Hos
Dep
Sore
Int
Pho
Obs
Dep
Som
Obs
Par
Anx
Psy

.63
.62
.62
.61
.60
.60
.59
.59
.58
.57
.57
.56
.54
.53
.53
.53
.51
.51
.51
.49
.49
.46
.44
.39

Som = Somatization; Obs = Obsessivecompulsive; Int = Interpersonalsensitivity; Dep = Depression;Anx = Anxiety; Hos = Hostility; Pho ffi Phobic anxiety; Para = Paranoid ideation; Psy = Psychoticism.

DISCUSSION

The purpose of this study was to critically evaluate the factor structure underlying the Brief
Symptom Inventory (BSI), a commonly used questionnaire designed to assess psychological distress. The hypothesized nine dimensions of the BSI were not supported via either
exploratory or confirmatory factor analyses. Although the one-factor model was the best
among all those tested in this study, this model (as well as the other models) was clearly
lacking in explanatory power. The goodness-of-fit indices all pointed to serious measurement deficiencies in the BSI.
The one factor structure identified in the present study is quite different from the vast
majority of earlier results which identified no fewer than three and typically as many as
nine factors. One possible explanation for this discrepancy is that, although the number of
factors found in this study is strikingly different from those identified in other studies, the
large amount of variance accounted for by the first factor in comparison to the second and
subsequent factors is similar throughout much of this body of research (e.g., Bonynge,
1993; Boulet and Boss, 1991; Brophy et al., 1988; Carpenter and Hittner, 1995; Cyr et al.,
1985; Hafkensheid, 1993). Furthermore, attempts to find support for the convergent valid-

Brief SymptonInventory

111

ity of the BSI subscales have been disappointing (e.g., Boulet and Boss, 1991). Taken as a
whole, these findings provide consistent support for the one-factor solution (i.e., global
distress) found in this study and highlights the BSI's inability to differentiate among nine
different types of psychological symptomatology. This finding is particularly important
given that researchers continue to use the BSI scales to evaluate the validity of other
psychological measures (e.g., Osman, 1995; Pincus, 1995). The goodness-of-fit indices,
however, clearly support the one-factor model for this sample over the two-factor model.
Although the results of this study certainly do not identify a nine-dimensional model, it
is important to note that there is a certain degree of conceptual support for a two-factor
solution. The two-factor model examined in this study was somewhat similar to a model
identified by Shutty and his colleagues (1986). They conducted a second-order CFA on the
SCL-90 after noting the high intercorrelations among the scales. In addition to identifying
a large factor associated with global distress, they identified three additional factors, one of
which was described as somatic anxiety. The two factors underlying Model 2 in this study
also appear to be measures of global distress and somatic anxiety.
A second possible explanation for the differences found in this study in comparison to
others' results centers around the fact that it was conducted on a sample of substance abusers and not on a more general clinical population such as was used by Derogatis. This
explanation, however, is unlikely given that the large amount of variance accounted for by
this first factor remains high across a variety of homogeneous (e.g., Boulet and Boss, 1991)
and heterogeneous (e.g., Hafkensheid, 1993) clinical populations.
A third possible explanation for the one factor solution identified in this study is the
degree of distress reported by the participants upon entering a substance abuse treatment
program. Although none of the participants were involved in the detoxification process at
the time they were assessed, the circumstances under which they entered treatment may
have affected their responses to the content of the BSI. About a third of the sample was
seeking treatment as a result of their interactions with the criminal justice system. As a
result, these participants may have denied high levels of distress. Such a response bias
would explain why the average scale scores were not inordinately high. Given that this
sample's average scores for the nine dimensions and the GSI were similar to the average
scores reported for the normative BSI clinical groups, this explanation does not seem
plausible.
Finally, further support of the one-factor solution is indicated by the fact that the results
were consistent across two different types of factor analyses conducted on two independent
samples of substance abusers.
Having highlighted a number of assessment-related issues and concerns, the practical
implications of using the BSI to better understand and treat substance abusers must also be
addressed. A key question that emerges as a result of these findings is: Should researchers
and clinicians continue to use the nine BSI dimensions? The results of this study provide
strong empirical evidence that caution should be exercised when using the individual BSI
scales. The specific subscales appear to be of highly limited utility in their present form.
This being the case, one should not assume that the BSI results provide unique information
about the client's degree of distress on each of the nine sub-scales.
This is not to say that the BSI cannot provide clinically useful information. Derogatis and
Spencer (1982) suggest that the BSI be interpreted on three different levels--at a global
level, a dimensional level, and a discrete symptom level. The results of this study suggests

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that the discrete symptom level and the global level of interpretation are useful. Clinicians
can examine the individual BSI items (i.e., discrete symptom level) and directly discuss
those highly rated items with their clients during the counseling session. By attending to
clients' responses to specific BSI items, clinicians will be exhibiting more ethical behavior
and may obtain information that could be crucial for identifying the need for immediate
intervention or long-term treatment planning.
In addition, research on the BSI and its predecessors suggests that the GSI score (i.e.,
global level) is a good overall indicator of emotional distress. Royse and Drude (1984)
found the GSI to be a useful tool for distinguishing between more and less severe substance
abusers. Enhancing clinicians' ability to identify different subgroups of substance abusers
has important implications for improving the client-treatment matching process which is
increasingly important given managed care's focus on accountability issues. The GSI can
also be re-assessed throughout the counseling process in order to evaluate change or treatment outcome.
Researchers and clinicians alike may obtain more accurate information by completing a
more comprehensive assessment procedure. This process might include other questionnaires (e.g., MMPI-2) and semi-structured interviews (e.g., Addiction Severity Index).
When using the BSI alone for clinical or research purposes one must question whether the
savings in time and labor is worth the loss of information regarding the nine proposed
symptom dimensions.

This research was supported by the Michigan Office of Substance Abuse

Services. The authors would like to acknowledge the thoughtful feedback provided by Betty Gridley
on the initial draft of this manuscript.

ACKNOWLEDGMENTS:

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