***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: BACKGROUND Drinking Less ( DL ) is a 24/7 free-access anonymous interactive web-based self-help intervention without therapeutic guidance for adult problem drinkers in the community . In a r and omized controlled trial ( referred to here as DL- RCT ) , DL has been shown effective in reducing risky alcohol consumption . OBJECTIVE To assess whether the findings of DL- RCT are generalizable to a naturalistic setting ( DL-RW ) in terms of ability to reach the target group and alcohol treatment response . METHODS Pretest-posttest study with 6-month follow-up . An online survey was conducted of 378 of the 1,625 people who used DL-RW from May to November 2007 . Primary outcome measures were ( 1 ) problem drinking , defined as alcohol consumption in the previous 4 weeks averaging > 21 or > 14 st and ard units ( male/female ) per week or > or=6 or > or=4 units ( m/f ) on 1 or more days per week ; and ( 2 ) mean weekly alcohol consumption . DL-RW and DL- RCT data were compared and pooled . Intention-to-treat ( ITT ) analysis was performed to analyze and compare changes in drinking from baseline to follow-up . RESULTS In the DL-RW group , 18.8 % ( n = 71 ) were drinking successfully within the limits of the Dutch guideline for low-risk drinking ( p < 0.001 ) 6 months after baseline ( ITT ) . The DL-RW group also decreased its mean weekly alcohol intake by 7.4 units , t(377 ) = 6.67 , p < 0.001 , d = 0.29 . Drinking reduction in DL-RW was of a similar magnitude to that in the DL- RCT condition in terms of drinking within the guideline [ chi(2)(1 ) = 1.83 , CI : 0.82 - 3.00 , p = 0.18 , RD = 0.05 , OR = 1.55 ] and mean weekly consumption ( a negligible difference of d = 0.03 in favor of DL-RW group ) . CONCLUSION The results from DL- RCT and DL-RW were similar , and they demonstrate that web-based self-help without therapeutic guidance is feasible , well accepted , and effective for curbing adult problem drinking in the community OBJECTIVE This article examines  client drinking and related psychosocial functioning during the course of alcoholism treatment .  It focuses on ( 1 ) the main effects of the three Project MATCH treatments , ( 2 ) the prognostic value of client attributes employed in the matching hypotheses , and ( 3 ) the attribute by treatment interaction effects . METHOD Clients recruited from outpatient setting s ( n = 952 ) or from aftercare setting s ( n = 774 ) were r and omized to one of the following treatments : Motivational Enhancement Therapy ( MET ) , Cognitive Behavioral Therapy ( CBT ) and Twelve-Step Facilitation ( TSF ) .  Alcohol consumption and psychosocial functioning during treatment were assessed at the end of the 12-week treatment phase . RESULTS During the treatment phase , small but statistically significant differences among treatments were found only in the outpatient arm on measures of alcohol consumption and alcohol-related negative consequences . Forty-one percent ( 41 % ) of CBT and TSF clients were abstinent or drank moderately without alcohol-related consequences , compared with 28 % of MET clients . Tests of 10 a priori primary client-treatment matching hypotheses failed to find any interaction effects that had an impact on drinking throughout the treatment phase . CONCLUSIONS In the outpatient setting there appears to be a temporary advantage to assigning individuals to CBT or TSF rather than MET . When there is a need to quickly reduce heavy drinking and alcohol-related consequences , it appears that CBT or TSF should be the treatment of choice Abstract In a r and omized trial , this study compared the longitudinal outcome patterns of veterans ( N = 66 ) with substance use disorders and major depressive disorder receiving st and ard pharmacotherapy and either 12-Step Facilitation Therapy ( TSF ) or disorder-specific Integrated Cognitive Behavioral Treatment ( ICBT ) .  Depression and substance use were assessed at intake , during and after treatment using the Hamilton Depression Rating Scale and the Time Line Follow Back . Reductions in depression during treatment were comparable between the two treatment groups ; however , their posttreatment patterns were distinct . While ICBT participants evidence d a steady linear decline in depression through six months posttreatment , a quadratic trend characterized TSF participants , for whom depression declined during treatment , but increased throughout posttreatment follow-up . During treatment , TSF participants used substances less frequently relative to those in ICBT ; however , reductions in substance use were more stable through six months posttreatment among those in ICBT relative to TSF . While both interventions produced improvement in depression and substance use during treatment , ICBT may yield more stable clinical outcomes once treatment ceases AIMS Previous research has reported that both contingency management ( CM ) and cognitive-behavioral therapy ( CBT ) are efficacious interventions for the treatment of stimulant abusers . The present study sought to directly compare the effectiveness of ( CM ) and ( CBT ) alone and in combination in reducing  stimulant use .  DESIGN R and omized clinical trial . PARTICIPANTS Stimulant-dependent individuals ( n = 171 ) . INTERVENTION CM , CBT or combined CM and CBT , 16-week treatment conditions . CM condition participants received vouchers for stimulant-free urine sample s. CBT condition participants attended three 90-minute group sessions each week . MEASUREMENTS Participants were interviewed at baseline and weeks 17 , 26 and 52 . Measures included psychiatric disorders and alcohol and drug use and concomitant social problems . FINDINGS CM procedures produced better retention and lower rates of stimulant use during the study period . Self-reported stimulant use was reduced from baseline levels at all follow-up points for all groups and urinalysis data did not differ between groups at follow-up . While CM produced robust evidence of efficacy during treatment application , CBT produced comparable longer-term outcomes . There was no evidence of an additive effect when the two treatments were combined . CONCLUSIONS This study suggests that CM is an efficacious treatment for reducing stimulant use and is superior during treatment to a CBT approach . CM is useful in engaging substance abusers , retaining them in treatment and helping them achieve abstinence from stimulant use . CBT also reduces drug use from baseline levels and produces comparable outcomes on all measures at follow-up OBJECTIVE To assess the benefits of matching alcohol dependent clients to three different treatments with reference to a variety of client attributes . METHODS Two parallel but independent r and omized clinical trials were conducted , one with alcohol dependent clients receiving outpatient therapy ( N = 952 ; 72 % male ) and one with clients receiving aftercare therapy following inpatient or day hospital treatment ( N = 774 ; 80 % male ) . Clients were r and omly assigned to one of three 12-week , manual-guided , individually delivered treatments : Cognitive Behavioral Coping Skills Therapy , Motivational Enhancement Therapy or Twelve-Step Facilitation Therapy . Clients were then monitored over a 1-year posttreatment period . Individual differences in response to treatment were modeled as a latent growth process and evaluated for 10 primary matching variables and 16 contrasts specified a priori . The primary outcome measures were percent days abstinent and drinks per drinking day during the 1-year posttreatment period . RESULTS Clients attended on average two-thirds of treatment sessions offered , indicating that substantial amounts of treatment were delivered , and research follow-up rates exceeded 90 % of living subjects interviewed at the 1-year posttreatment assessment . Significant and sustained improvements in drinking outcomes were achieved from baseline to 1-year posttreatment by the clients assigned to each of these well-defined and individually delivered psychosocial treatments . There was little difference in outcomes by type of treatment . Only one attribute , psychiatric severity , demonstrated a significant attribute by treatment interaction : In the outpatient study , clients low in psychiatric severity had more abstinent days after 12-step facilitation treatment than after cognitive behavioral therapy . Neither treatment was clearly superior for clients with higher levels of psychiatric severity . Two other attributes showed time-dependent matching effects : motivation among out patients and meaning-seeking among aftercare clients . Client attributes of motivational readiness , network support for drinking , alcohol involvement , gender , psychiatric severity and sociopathy were prognostic of drinking outcomes over time . CONCLUSIONS The findings suggest that psychiatric severity should be considered when assigning clients to outpatient therapies . The lack of other robust matching effects suggests that , aside from psychiatric severity , providers need not take these client characteristics into account when triaging clients to one or the other of these three individually delivered treatment approaches , despite their different treatment philosophies Few integrated substance use and depression treatments have been developed for delivery in outpatient substance abuse treatment setting s. To meet the call for more " transportable " interventions , we conducted a pilot study to test a group cognitive-behavioral therapy ( CBT ) for depression and substance use that was design ed for delivery by outpatient substance abuse treatment counselors . Seventy-three outpatient clients were r and omized to usual care enhanced with group CBT or usual care alone and assessed at three time points ( baseline and 3 and 6 months postbaseline ) . Our results demonstrated that the treatment was acceptable and feasible for delivery by substance abuse treatment staff despite challenges with recruiting clients . Both depressive symptoms and substance use were reduced by the intervention but were not significantly different from the control group . These results suggest that further research is warranted to enhance the effectiveness of treatment for co-occurring disorders in these setting Depression is the most common comorbid psychiatric illness in patients with alcohol dependence . This double-blind study tested the efficacy of nefazodone versus placebo for the treatment of depression in actively drinking alcohol-dependent patients who were also participating in weekly group treatment for alcoholism . Sixty-four subjects with major depression disorder and alcohol dependence with a history of at least one prior episode of depression when not drinking were r and omly assigned to receive 12 weeks of either nefazodone or placebo and participated in a weekly psychoeducational group on alcoholism . Subjects were assessed every 2 weeks for depression , anxiety , side effects , and drinking frequency . Subjects taking nefazodone were significantly more likely to complete the study ( 62 % ) than those taking placebo ( 34 % ) . Analyses of covariance using drinks per week as a time-dependent covariate showed lower Hamilton Rating Scale for Depression scores at week 8 for end-point analysis and at weeks 8 and 12 for completers . The endpoint analysis demonstrated a significantly greater response in the nefazodone group ( 48 % ) than in the placebo group ( 16 % ) . Both groups showed a similarly significant decrease in the average number of alcoholic drinks consumed per day over the course of the study . Although the number of adverse effects was significantly greater for the nefazodone group , there were no severe adverse events , and nefazodone was well tolerated . Nefazodone is a safe and effective antidepressant to use in a population of alcohol-dependent patients with depression who have a high degree of comorbidity .  Nefazodone treatment was superior to placebo in alleviating depression in these patients but did not add any advantage over the psychoeducational group in terms of drinking outcomes Objective : To evaluate the efficacy of the Flinders Program ™ of chronic condition management on alcohol use , psychosocial well-being and quality of life in Vietnam veterans with alcohol misuse . Method : This 9-month wait-list , r and omised controlled trial used the Alcohol Use Disorders Identification Test ( AUDIT ) score ≥ 8 as the entry criterion . Intervention veterans received  the Flinders Program plus usual care and controls received usual care . The primary outcome measure was AUDIT score at baseline , 3 , 6 and 9 months . Secondary measures included quality of life , alcohol dependence ( DSM-IV ) , anxiety and depression . All measures were repeated at variable trial end date s between 9 and 18 months in the intervention group . Results : R and omisation result ed in 46 intervention and 31 control participants . Intent-to-treat analyses showed AUDIT scores improved significantly from baseline to 9-month follow-up ( p = 0.039 ) in the intervention group compared to control group . The control group had 1.46 times the risk of alcohol dependence than the intervention group at 9 months ( p = 0.027 ) . There were no significant differences between groups for secondary measures . Within-group analyses showed that both groups significantly improved in AUDIT ( p < 0.001 ) , anxiety and depression ( p < 0.01 ) , anger ( p < 0.001 ) , and post-traumatic stress ( p < 0.01 ) . Improvements in AUDIT ( p < 0.001 ) and alcohol dependence were maintained in the intervention group to 18 months . Conclusions : Use of the Flinders Program in addition to usual care result ed in reduced alcohol use , reduced alcohol dependence , and global clinical improvement in Vietnam veterans with risky alcohol behaviours and chronic mental health problems . The findings demonstrate that the Flinders Program provides a structured framework for delivering self-management support , case management and coordinated care for people with chronic conditions . This clinical approach has the potential to bridge the gap between physical and mental illness service delivery for people with long-term conditions in Australia AIMS To evaluate computer- versus therapist-delivered psychological treatment for people with comorbid 
    Output:
    
Subgroup analyses revealed no significant differences for both AUD and MDD .
Combined cognitive-behavioural therapy and motivational interviewing for clinical or sub clinical depressive and alcohol use disorders has a small but clinical ly significant effect in treatment outcomes compared with treatment as usual