***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Relapse outcomes at 6- , 12- , and 18-month intervals were compared between clients r and omly assigned to day ( n=114 ) versus residential ( n=147 ) drug abuse treatment . Day clients were more likely than residential clients to relapse 6 months post-admission ( OR=3.06 , p<0.001 ) ; however , no setting differences at 12 or 18 months were found . Few baseline predictors were prospect ively related to relapse at 12 and 18 months . These predictors were usual employment status ( part-time OR=17.47 , p<0.001 ; full-time OR=2.54 , p<0.001 ) , history of drug injecting ( OR=5.39 , p<0.01 ) , multiple sex partners ( OR=1.16 , p<0.01 ) , and not having a gay sexual partner ( OR=0.05 , p<0.03 ) during 6 months prior to admission . Still , these baseline predictors , together with the existing literature , could be used by drug treatment professionals to identify individuals who may be at high risk for relapse over time , and to offer specialized treatment and aftercare re sources as intervention and prevention measures Extending an earlier report of 6-month outcomes , this study reports 12- and 18-month follow-up data for clients ( N = 188 ) entering a therapeutic community drug treatment program who were r and omly assigned to day or residential treatment conditions .  Outcomes included Addiction Severity Index composite scores and measures of depression , psychiatric symptoms , and social support . Both groups showed significant change over time . The pattern of change indicated decreased problem severity in the 1st 6 months and then maintenance of lowered problem severity . Comparisons between groups indicated greater improvement for residential treatment clients on social problems and psychiatric symptoms but no differences on the remaining outcomes . Although residential treatment may offer some specific advantages , the conclusion here is that improvement among day treatment clients was not significantly different from that of residential treatment clients This study reports on a comparative empirical investigation into the effects of treating alcoholics and drug addicts together as opposed to separately . Four hundred fifty subjects who had been r and omly assigned to combined and separate treatment were followed eight months post treatment . The study reports on general effects of outcome of treating alcoholics and drug addicts together rather than separately and moves on to ascertain whether certain subgroups of alcoholics and drug addicts might do better or worse in combined or separate treatment . In general , neither drug addicts nor alcoholics did worse on any of the outcome measures . Furthermore none of the subgroups did better or worse in combined or separate treatment . The study provides support for combined treatment  of  alcoholics and drug addicts as a feasible alternative to separate treatment A women 's therapeutic community ( TC ) design ed to prevent homelessness was evaluated using a quasi-experimental process . Propensity analysis selected comparable experimental ( E ) and comparison ( C ) participants . Significant improvements were found for the E group at the domain level , both in “ psychological ” dysfunction on symptoms ( e.g. , depression ) , and in “ health , ” including ratings of health and adherence to medication regimens . No significant difference was found at the domain level for “ parenting ” or “ housing stabilization , ” but specific outcomes did differ . For example , a greater number of children resided with the E  group mothers who also assumed financial responsibility for more of their children In assessing the socioenvironmental characteristics of psychiatric treatment programs , research ers typically assume that their measurements are unaffected by client characteristics . However , our analysis among mentally ill chemical abusers in a therapeutic community and community residences found significant associations between subscales of the Community Oriented Program Evaluation Scale ( COPES ) and depressive symptoms , as measured by the CES-D , after 2 , 6 , and 12 months of treatment . Investigators of treatment environments should consider depressive symptoms as a possible threat to the validity of their findings Clients entering a therapeutic community (TC)-oriented drug treatment program  were r and omly assigned to day or residential conditions and interviewed at 2 weeks and 6 months after admission . Outcomes included Addiction Severity Index composite scores and summary scores for the Beck Depression Inventory , Symptom Checklist-90-R , and a social support scale .  Only clients who remained in treatment for at least 2 weeks were included . The mean age of the sample ( N = 261 ) was 32.9 ( SD = 6.7 years ) and the mean education level was 12.1 years ( SD = 1.9 years ) ; 30 % were women . Comparison of outcome scores at 6 months between groups , while controlling for baseline values , indicated greater improvement for residential clients on social problems and psychiatric symptoms . The groups were similar on the 8 remaining outcomes , including measures of alcohol and drug problems . Overall , the level of improvement among day treatment clients was not significantly different from that of residential clients This study compared treatment outcomes of substance abusers with and without antisocial personality disorder ( APD ) r and omly assigned to two therapeutic communities , differing primarily in length of inpatient and outpatient treatment . We hypothesized that APD clients would be less likely to complete treatment , more likely to test positive for drugs and recidivate at follow-up , and that APD clients in the St and ard program would have more favorable outcomes than those in the Abbreviated Inpatient program , because of the St and ard program 's longer inpatient treatment . Self-reports and objective measures of criminal activity and substance abuse were collected at pre- and posttreatment interviews . APD clients were as likely to complete treatment as other clients , and they exhibited the same patterns of reduced drug use and recidivism as did non-APD clients . Treatment program attended was unrelated to outcomes . Substance abusers diagnosed with APD can benefit from treatment in a therapeutic community combined with outpatient care OBJECTIVES The feasibility and effectiveness of treating homeless mentally ill chemical abusers in community residences compared with a therapeutic community were evaluated . METHODS A total of 694 homeless mentally ill chemical abusers were r and omly referred to two community residences or a therapeutic community . All programs were enhanced to treat persons with dual diagnoses . Subjects ' attrition , substance use , and psychopathology were measured at two , six , and 12 months . RESULTS Forty-two percent of the 694 referred subjects were admitted to their assigned program and showed up for treatment , and 13 percent completed 12 months or more . Clients retained at both types of program showed reductions in substance use and psychopathology , but reductions were greater at the therapeutic community . Compared with subjects in the community residences , those in the therapeutic community were more likely to be drug free , as measured by urine analysis and self-reports , and showed greater improvement in psychiatric symptoms , as measured by the Center for Epidemiological Studies --Depression Scale and the Brief Psychiatric Rating Scale . Their functioning also improved , as measured by the Global Assessment of Functioning scale . CONCLUSIONS Homeless mentally ill chemical abusers who are retained in community-based residential programs , especially in therapeutic communities , can be successfully treated This study examines the efficacy of providing Enhanced Abbreviated or St and ard Inpatient treatment and Outpatient treatment to drug-abusing clients . The experiment r and omly assigned 412 clients to two therapeutic community programs  , which differed primarily in planned duration . This study addressed limitations of prior research , as it used r and om assignment of clients to treatment programs , achieved high follow-up rates and used objective measures of drug use and criminal history . Self-reports and objective measures of criminal activity and substance abuse were collected at pre- and posttreatment interviews . Completing the entire 12-month program ( inpatient and outpatient ) was more important than duration of inpatient program attended . Regardless of program , completers had substantial reductions in posttreatment drug abuse and arrests . A 12-month course of treatment including at least 6 months in a therapeutic community followed by outpatient treatment can produce marked reductions in drug abuse and crime among persons who complete both phases The New Jersey Substance Abuse Treatment Campus was funded to assess the feasibility of establishing a new model for delivering substance abuse treatment services and to serve as a research laboratory for conducting comparative evaluations of those services . The 350-bed campus was design ed to improve treatment effectiveness by providing special services needed by underserved population s , and reduce treatment costs by serving large numbers of clients , central izing services , and sharing facilities . First-time clients who met preliminary eligibility requirements during phone screening were r and omly assigned to therapeutic community  and  chemical dependency  programs . We used data collected on 1,573 adults who were ultimately accepted for admission to analyze  treatment refusals and attrition during the 25 days after admission . Only 6.4 % of the clients refused admission when informed of their treatment assignment . Planned duration of the residential phase of treatment , gender , and language spoken ( English/Spanish ) interacted with one another and differentially predicted treatment refusal/attrition . These findings may be useful for underst and ing treatment refusal and attrition in substance abuse treatment programs This study compares the efficacy of three residential therapeutic communities and an outpatient methadone maintenance program for 585 male veterans addicted to heroin . Subjects were r and omly assigned to the treatment modalities . More than 93 % of the subjects completed both six- and 12-month question naires . In this report , the treatment setting s , characteristics of the sample , assignment protocol , and pattern of treatment entry and first-year follow-up results are outlined . The various clinical dem and s that affected the research protocol , the degree to which the r and omization was compromised , and the implication s for the analysis of outcome are discussed . One year after admission to the study , subjects who had been in a therapeutic community for longer than seven weeks or in methadone treatment were more likely to be employed or attending school , and less likely to be in jail , using heroin , or to have been convicted of a serious crime , than subjects who received no treatment at all beyond a short detoxification period . Those who spent less than seven weeks in a therapeutic community were doing no better than subjects in the no treatment group In recent years , one response to drug abuse problems has been to provide treatment in prison and probation setting s. Results are promising , although the need for improving m and ated treatment has been expressed . The Cognitive Enhancements for Treatment of Probationers ( CETOP ) project is investigating cognitive enhancements in a modified therapeutic community ( TC ) setting . One enhancement is node-link mapping , a visual graphing strategy . Map " nodes " contain ideas , actions , and feelings ; these are connected by links that illustrate meaningful relationships . Current findings indicate increases in group participation , ratings of session depth , and positive ratings of coresidents , counselors , and security staff . The present study extends this research by comparing mapping-enhanced counseling to st and ard counseling on self-efficacy and motivation for basic psychosocial skills ( e.g. , emotional control ) . Probationers ( n = 381 ) in a 16-week residential program were assigned r and omly to conditions in 12 TCs ( n = 30 - 35 ) .  Motivation and self-efficacy were assessed by two self-report question naires , one midway and one at the end of treatment . A five-factor solution was produced from each question naire . With community as the unit of analysis , means of enhanced counseling were higher in all cases . Wilcoxen tests indicated four significant differences at midterm for mapping on motivation and self-efficacy of communication and emotional control ( p < .05 ) . At the end of treatment , mapping was higher for motivation of cognition and emotional control and self-efficacy was higher for communication . Discussing B and ura 's model , these findings provide evidence that maps may enhance psychosocial skills , which have been associated with maintaining recovery AIMS Two r and omized controlled trials of residential drug abuse treatment programs found the programs to be equally effective , based on outcomes among those assigned to the treatments . This study aim ed to compare the relative efficacy of the programs , based on outcomes among those who received the specific treatment program as planned . DESIGN Secondary analyses of data from two concurrent r and omized controlled trials , with stratification by actual length of stay . SETTING Two residential drug abuse treatment facilities in the United States . PARTICIPANTS Six hundred and twenty-eight clients were enrolled over a 2-year period , representing 85 % of all clients admitted , 91 % of all eligible clients , and 95 % of those asked to participate . INTERVENTIONS At one facility , clients were r and omized to 3-month or 6-month versions of a traditional therapeutic community program . At the second facility , clients were r and omized to 3-month or 6-month versions of a modified therapeutic community program that emphasized relapse prevention and health education . MEASUREMENTS Time from admission to first drug use ( except alcohol ) ; and Addiction Severity Index ( ASI ) composite scores for severity of drug , alcohol , legal , and employment problems . FINDINGS Five hundred and thirty-nine clients ( 86 % ) completed a follow-up interview at least 16.5 months after admission . In the relapse prevention trial , benefits of the 6-month program were generally limited to those who stayed at least 40 days . In the therapeutic community trial , among those who stayed at least 171 days , the 12-month program had a beneficial effect on employment . Otherwise , there were inconsistent differences between the 6- and 12-month programs . CONCLUSIONS On average , clients who stayed in treatment at least 80 days benefited from continuing in treatment for up to 6 months , but not beyond . Conversely , those admitted to programs of longer planned duration who dropped out of treatment early had worse outcomes than those who dropped out of shorter programs . Thus , although longer planned duration of treatment may be efficacious , it is not effective This study compared factors that predict treatment outcomes in men and women r and omly assigned to two therapeutic communities differing primarily in length of inpatient and outpatient treatment . 
    Output:
    
There is little evidence that TCs offer significant benefits in comparison with other residential treatment , or that one type of TC is better than another .
Prison TC may be better than prison on it 's own or Mental Health Treatment Programmes to prevent re-offending post-release for in-mates .