***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: OBJECTIVE This study examined whether substance abuse patients self- selecting into one of three aftercare groups ( outpatient treatment only , 12-step groups only , and outpatient treatment and 12-step groups ) and patients who did not participate in aftercare differed on 1-year substance use and psychosocial outcomes . METHOD A total of 3,018 male patients filled out a question naire at intake and 1 year following discharge from treatment . Patients were classified into aftercare groups at follow-up using information from VA data bases and self-reports . RESULTS Patients who participated in both outpatient treatment and 12-step groups fared the best on 1-year outcomes . Patients who did not obtain aftercare had the poorest outcomes . In terms of the amount of intervention received , patients who had more outpatient mental health treatment , who more frequently attended 12-step groups or were more involved in 12-step activities had better 1-year outcomes . In addition , patients who kept regular outpatient appointments over a longer time period fared better than those who did not . CONCLUSIONS Encouraging substance abuse patients to regularly attend both outpatient aftercare and self-help groups may improve long-term outcomes BACKGROUND Contingency management ( CM ) and significant other involvement ( SO ) were evaluated as strategies to enhance treatment retention , medication compliance , and outcome for naltrexone treatment of opioid dependence . METHODS One hundred twenty-seven recently detoxified opioid-dependent individuals were r and omly assigned to 1 of 3 conditions delivered for 12 weeks : ( 1 ) st and ard naltrexone treatment , given 3 times a week ; ( 2 ) naltrexone treatment plus contingency management ( CM ) , with delivery of vouchers contingent on naltrexone compliance and drug-free urine specimens ; or ( 3 ) naltrexone treatment , CM , plus significant other involvement ( SO ) , where a family member was invited to participate in up to 6 family counseling sessions . Principal outcomes were retention in treatment , compliance with naltrexone therapy , and number of drug-free urine specimens . RESULTS First , CM was associated with significant improvements in treatment retention ( 7.4 vs 5.6 weeks ; P = .05 ) and in reduction in opioid use ( 19 vs 14 opioid-free urine specimens ; P = .04 ) compared with st and ard naltrexone treatment . Second , assignment to SO did not significantly improve retention , compliance , or substance abuse outcomes compared with CM . Significant effects for the SO condition over CM on retention , compliance , and drug use outcomes were seen only for the subgroup who attended at least 1 family counseling session . The SO condition was associated with significant ( P = .02 ) improvements in family functioning . CONCLUSION Behavioral therapies , such as CM , can be targeted to address weaknesses of specific pharmacotherapies , such as noncompliance , and thus can play a substantial role in broadening the utility of available pharmacotherapies We examined the effectiveness of a contingency management program in preventing relapse to  illicit opiate use  and increasing treatment retention during outpatient methadone detoxification treatment . Twenty male opiate addicts were r and omly assigned to an experimental or control group . Following a 3-week methadone stabilization period , men in both groups received identical gradual methadone dose reductions during Weeks 4 through 9 and were maintained on placebo during Weeks 10 through 13 . Beginning in Week 4 , control patients received $ 5.00 for providing a specimen twice weekly . Experimental patients received $ 10.00 and a take home methadone dose for each opiate-free urine specimen but forfeited the incentives and participated in more intensive clinic procedures when specimens were opiate positive . The contingency management procedure slowed the rate of relapse to illicit opiate use . Experimental patients provided significantly more opiate-free urines during the methadone dose reduction in Weeks 4 through 9 than control patients , although the difference between groups was no longer significant during placebo administration in Weeks 10 through 13 . In addition , the contingency management program improved treatment retention and reduced symptom complaints during the detoxification . The usefulness and limitations of contingency management procedures  for outpatient methadone detoxification are discussed This controlled study examined the efficacy of reinforcement-based therapy ( RBT ) for producing enhanced abstinence outcomes over 12 months in opioid-dependent patients exiting a brief residential detoxification . Patients were r and omly assigned upon completing their medically managed taper ( i.e. , detoxification ) to RBT ( N=66 ) or usual care ( N=64 ) referral to community treatment programs . The 6-month RBT program offered an array of abstinence-based incentives including rent payment for recovery housing , program-led recreational activities and skills training for procuring employment . RBT produced significantly higher self-report and urinalysis-confirmed rates of abstinence from opioids and cocaine relative to usual care at 1 ( 42 % versus 15 % ) and 3 ( 38 % versus 17 % ) months during treatment but not at 6 or 12 months after enrollment . The RBT but not the usual care group showed significant increases in the number of days worked and the amount of legal income earned at 3 , 6 and 12 months . The results of this r and omized study suggest that an intensive reinforcement-based therapy that includes abstinence-based recovery housing is a promising approach ; however , further research is needed to determine the role of treatment intensity and the specific efficacy of RBT 's component parts This study evaluated the short-term effectiveness of cognitive-behavioral treatment ( CBT ) for substance abuse delivered in a community setting . At entry into outpatient community substance abuse treatment , participants ( N = 252 ) were r and omly assigned to 3 conditions : high-st and ardization CBT , low-st and ardization CBT , and treatment as usual . Treatment consisted of 12 weekly individual therapy sessions . There was a significant decrease in substance use from baseline , with participants reporting being abstinent on 90 % of within-treatment days and 85 % of days during the 6 months posttreatment . However , there were no significant differences in outcomes across conditions . Findings do not support the hypothesis that disseminating CBT to community setting s will improve outcomes and suggest that st and ard substance abuse counseling may be more effective than previously thought We evaluated 3-month outcomes for reinforcement-based intensive outpatient treatment ( RBT ) , a new relapse prevention behavior therapy for inner city opiate abusers . The therapy provides abstinence-contingent partial support of housing , food and recreational activities , abstinence-contingent access to social skills and job finding group therapy and non-contingent individual counseling , all in the context of a day treatment program . Heroin abusers ( n = 52 ) , contacted at a 3-day detoxification unit , were r and omly assigned to RBT ( n = 28 ) or referred to community treatment re sources ( n = 24 ) after a staff escort from the detoxification unit . For RBT patients , treatment began on the day of discharge ; 61 % received partial rent support in a recovery house based on the need for drug-free housing ; the remainder were eligible for partial support of utility payments where they lived . Abstinence-based contingencies were in effect for 1 month with three times per week counseling available for an additional 2 months . One month after detoxification , 61 % of RBT versus 17 % of referral patients were enrolled in outpatient treatment ( P < 0.01 ) ; RBT patients were significantly less likely than controls to have returned to any drug use ; and 50 % of RBT versus 21 % of controls reported 30 days of abstinence from heroin and cocaine with confirmatory negative urine ( P < 0.05 ) . RBT patients had significantly lower scores on the Beck Depression Inventory at 1 month ( M = 9.0 versus 17.6 for controls ; P < 0.05 ) and showed evidence of less alcohol use and higher rates of employment . These results establish the short-term efficacy for RBT and support continued development and evaluation of this new outpatient behavioral treatment This study examined the effects of contingent vs. non-contingent delivery of a methadone dose supplement on  relapse to illicit opiate use  in the context of a methadone outpatient detoxification program . Following a 3-week methadone stabilization period on 30 mg , patients ( N = 39 ) were r and omly assigned to a contingent , a non-contingent , or a control treatment group . All patients received identical gradual reductions in their assigned methadone dose . During the dose reduction period ( weeks 4 - 11 ) , members of the contingent ( N = 13 ) and non-contingent groups ( N = 13 ) could obtain daily methadone-dose supplements up to 20 mg , but contingent group members could obtain supplements only if their most recent urinalysis results were opiate negative . Control subjects ( N = 13 ) did not have dose increases available . The contingent group presented significantly lower opiate-positive urines during weeks 8 - 11 ( 14 % positive ) of the detox than the non-contingent ( 38 % positive ) or control ( 50 % positive ) groups . Additionally , the availability of extra methadone  improved treatment retention and increased clinic attendance above levels observed in the control group . The potential for further use of methadone 's reinforcing properties in the treatment of opiate dependence is discussed We examined the effect of a case management intervention on drug treatment entry among injection drug users ( IDUs ) with and without comorbid antisocial personality disorder ( ASPD ) . Injection drug users attending the Baltimore Needle Exchange Program who sought and were granted referrals to opioid agonist treatment  were r and omized to receive a strengths-based case management intervention or passive referral . Of 162 IDUs , 22.8 % met the DSM-IV criteria for ASPD . Compared to those without ASPD , IDUs with comorbid ASPD who spent 25 or more minutes with their case manager prior to their treatment entry date were 3.51 times more likely to enter treatment than those receiving less than 5 min , adjusting for intervention status , race , and treatment site ( 95 % confidence interval 1.04–11.89 ) . Providing case management services to IDUs with comorbid ASPD may facilitate treatment entry and reduce the negative consequences of drug abuse Affiliation with Alcoholics Anonymous ( AA ) and other 12-Step self-help groups is becoming more common at the same time as professional substance abuse treatment services are becoming less available and of shorter duration . As a result of these two trends , patients ' outcomes may be increasingly influenced by the degree to which professional treatment programs help patients take maximum advantage of self-help groups . The present study of 3018 treated veterans examined how the theoretical orientation of a substance abuse treatment program affects ( 1 ) the proportion of its patients that participate in  self-help groups  , and , ( 2 ) the degree of benefit patients derive from participation in self-help groups . Patients treated in 12-Step and eclectic treatment programs had higher rates of subsequent participation in 12-Step self-help groups than did patients treated in cognitive behavioral programs . Furthermore , the theoretical orientation of treatment moderated the outcome of self-help group participation : As the degree of programs ' emphasis on 12-Step approaches increased , the positive relationships of 12-Step group participation to better substance use and psychological outcomes became stronger . Hence , it appears that 12-Step oriented treatment programs enhance the effectiveness of 12-Step self-help groups .  Findings are discussed in terms of implication s for clinical practice and for future evaluations of the combined effects of treatment and self-help groups OBJECTIVE This study examined whether enhancing st and ard aftercare with an outreach case management intervention would improve patients ' quality of life .  METHODS A sample of 292 patients discharged from an inpatient psychiatry service at an urban general hospital were r and omly assigned either to an intervention group ( N = 147 ) , which received outreach case management services in addition to st and ard aftercare service , or to a control group ( N = 145 ) , which received only st and ard aftercare services . The follow-up period was 15 to 52 months . Individuals in both groups were reinterviewed by an independent research team about 21.6 months after discharge . The groups were compared using 39 measures of quality of life . The interviews elicited information about patients ' physical well-being and competence in performing activities of daily living ; their emotional well-being as shown in emotional expressiveness , sadness , suicidal thoughts , and substance abuse ; and their interpersonal relationships , living arrangements , friendships , income maintenance , and employment . RESULTS No difference was found between the groups on any of the quality -of-life variables . CONCLUSIONS Outreach case management was not associated with improved quality of life OBJECTIVE To compare outcomes , costs and incremental cost-effectiveness of heroin detoxification performed in a specialist clinic and in general practice . DESIGN AND SETTING R and omised controlled trial set in a specialist outpatient drug treatment centre and six office-based general practice s in inner city Sydney , Australia . PARTICIPANTS 115 people seeking treatment for heroin dependence , of whom 97 ( 84 % ) were reinterviewed at Day 8 , and 78 ( 68 % ) at Day 91 . INTERVENTIONS Participants were r and omly allocated to primary care or a specialist clinic , and received buprenorphine for 5 days for detoxification , then were offered either maintenance therapy with methadone or buprenorphine , relapse prevention with naltrexone , or counselling alone . 
    Output:
    
In respect of the use of heroin during the treatment , the differences were not statistically significant but favoured the combined treatments .
REVIEW ERS ' CONCLUSIONS Psychosocial treatments offered in addition to pharmacological detoxification treatments are effective in terms of completion of treatment , results at follow-up and compliance .
Although a treatment , like detoxification , that exclusively attenuates the severity of opiate withdrawal symptoms can be at best partially effective for a chronic relapsing disorder like opiate dependence , this type of treatment is an essential step prior to longer-term drug-free treatment and it is desirable to develop adjunct psychosocial approaches that might make detoxification more effective .