***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: AIMS This study tested the hypothesis that patients with more severe substance use disorders ( SUDs ) at intake respond better when treated in more structured and intensive setting s ( i.e. in-patient/residential versus out-patient ) , whereas patients with less severe SUD problems have similar outcomes regardless of treatment setting . DESIGN , SETTING AND PARTICIPANTS Up to 50 new patients were selected r and omly from each of a r and om and representative sample of 50 Department of Veterans Affairs ( VA ) SUD treatment programs ( total n = 1917 patients ) , and were followed-up an average of 6.7 months later ( n = 1277 ) . MEASURES Patients completed a  brief self-report version of the Addiction Severity Index ( ASI ) at baseline and at follow-up . FINDINGS In mixed-model regression analyses , baseline substance use severity predicted follow-up substance use severity and there were no main effects of treatment setting . However , interaction effects were found , such that more severe patients experienced better alcohol and drug outcomes following in-patient/residential treatment versus out-patient treatment ; on the other h and , patients with lower baseline ASI drug severity had better drug outcomes following out-patient treatment than in-patient treatment . Treatment setting was unrelated to alcohol outcomes in patients with less severe ASI alcohol scores . CONCLUSIONS Results provide some support to the matching hypothesis that for patients who have higher levels of substance use severity at intake , treatment in in-patient/residential treatment setting s is associated with better outcomes than out-patient treatment . More research needs to be conducted before in-patient/residential setting s are further reduced as a part of the SUD continuum of care in the United States Objective : To determine the prevalence of concurrent personality disorders ( PDs ) among alcoholic men and women seeking outpatient treatment , and to examine their effect on the course of alcohol treatment . Method : Patients with alcohol use disorders ( n = 165 ) were assessed by clinical and semi-structured interviews , as well as self-report scales , to measure levels of psychological distress , impulsivity , social functioning , and addiction severity at treatment intake . PD diagnoses were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , Personality Disorder ( SCID-II ) . Course in treatment was monitored prospect ively for 12 weeks . Results : Using the results of the SCID-II ( n = 138 ) , the sample was divided into 3 groups — that is , no PD 41 % ( n = 57 ) , Cluster B PD 32 % ( n = 44 ) , and other PD 27 % ( n = 37 ) . The 3 groups did not differ in their alcohol use severity at intake . However , the Cluster B PD group achieved alcohol milestones at a younger age . Subjects with a PD had more severe psychological and social problems at intake . The Cluster B PD group showed significantly higher levels of impulsivity at intake , greater likelihood of early treatment dropout , and quicker times to first slip and to relapse . Conclusions : This study supports the high prevalence of concurrent PDs , particularly Cluster B PDs , among treatment-seeking alcoholics . The relation between observed high levels of impulsivity and worse course in early alcohol treatment among people with a Cluster B PD merits further investigation BACKGROUND Our initial attempts to " match " substance-abuse patients from an  employee assistance program to an optimal setting or program failed . Scientifically , we found no differential predictors of better outcomes by setting or program . From a practical perspective , it was impossible to place patients in the intended programs . This led to a second study , design ed to identify specific patient problems and match professional services to those problems within each of the 4 programs . METHODS Ninety-four new patients admitted to 4 substance-abuse treatment programs were r and omly assigned to st and ard treatment and treated in the usual manner or were assigned to " matched " services , in which patients received at least 3 professional sessions directed at their important employment , family , or psychiatric problems . RESULTS Matched patients stayed in treatment longer , were more likely to complete treatment , and had better posttreatment outcomes than did the st and ard patients treated in the same programs . CONCLUSIONS For logistical , financial , and clinical reasons , it is improbable that patients will be matched to specific types of programs . However , within any program , it is possible and practical to match appropriate services to patients ' specific treatment problems . This strategy was clinical ly and administratively practical , attractive to patients , and responsible for a 20 % to 30 % increase in the effectiveness of this substance-abuse treatment system To investigate the impact of counselor style , a 2-session motivational checkup was offered to 42 problem drinkers ( 18 women and 24 men ) who were r and omly assigned to 3 groups : ( a ) immediate checkup with directive-confrontational counseling , ( b ) immediate checkup with client-centered counseling , or ( c ) delayed checkup ( waiting-list control ) . Overall , the intervention result ed in a 57 % reduction in drinking within 6 weeks , which was maintained at 1 year . Clients receiving immediate checkup showed significant reduction in drinking relative to controls . The 2 counseling styles were discriminable on therapist behaviors coded from audiotapes . The directive-confrontational style yielded significantly more resistance from clients , which in turn predicted poorer outcomes at 1 year . Therapist styles did not differ in overall impact on drinking , but a single therapist behavior was predictive ( r = .65 ) of 1-year outcome such that the more the therapist confronted , the more the client drank AIMS Post-discharge monitoring and early reintervention have become st and ard practice when managing numerous chronic conditions . These two experiments tested the effectiveness of recovery management checkup ( RMC ) protocol s for adult chronic substance users . INTERVENTION RMC included quarterly monitoring ; motivational interviewing to provide personalized feedback and to resolve ambivalence about substance use ; treatment linkage , engagement and retention protocol s to increase the amount of treatment received . PARTICIPANTS AND SETTING Recruited from sequential addiction treatment admissions , participants in the two experiments were , on average , 36 and 38 years of age , mainly female ( 59 % versus 46 % ) , African American ( 85 % versus 80 % ) and met past-year criteria for dependence ( 87 % versus 76 % ) . DESIGN Participants in both experiments were assigned r and omly to the RMC or control condition and interviewed quarterly for 2 years . MEASUREMENT The Global Appraisal of Individual Needs ( GAIN ) was the main assessment instrument . FINDINGS RMC participant outcomes were better than control participants in both experiments . Effect sizes were larger in the second experiment in terms of reducing days to readmission ( Cohen 's d = 0.41 versus d = 0.22 ) , successive quarters in the community using substances ( d = -0.32 versus -0.19 ) , past-month symptoms of abuse/dependence ( d = -0.23 versus -0.02 ) and increasing the days of abstinence over 2 years ( d = + 0.29 versus 0.04 ) . CONCLUSION RMC , which provided ongoing monitoring and linkage , is feasible to conduct and is effective for adults with chronic substance dependence This study reports 3-year outcomes for clients who had been treated in the five outpatient sites of Project MATCH , a multisite clinical trial design ed to test a priori client treatment matching hypotheses . The main purpose of this study was to characterize the status of the matching hypotheses at the 3-year follow-up . This entailed investigating which matching findings were sustained or even strengthened across the 3-year study period , and whether any hypotheses that were not supported earlier eventually emerged at 3 years , or conversely , whether matching findings discerned earlier dissipated at this later time . This research also examines the prognostic effects of the client matching attributes , characterizes the overall outcomes at 37 to 39 months , and explores differential effects of the three treatments at extended follow-up . With regard to the matching effects , client anger demonstrated the most consistent interaction in the trial , with significant matching effects evident at both the 1-year and 3-year follow-ups . As predicted , clients high in anger fared better in Motivational Enhancement Therapy ( MET ) than in the other two MATCH treatments : Cognitive-Behavioral Therapy ( CBT ) and Twelve-Step Facilitation ( TSF ) . Among subjects in the highest third of the anger variable , clients treated in MET had on average 76.4 % abstinent days , whereas their counterparts in the other two treatments ( CBT and TSF ) had on average 66 % abstinent days . Conversely , clients low in anger performed better after treatment in CBT and TSF than in MET . Significant matching effects for the support for drinking variable emerged in the 3-year outcome analysis , such that clients whose social networks were more supportive of drinking derived greater benefit from TSF treatment than from MET . Among subjects in the highest third of the support for drinking variable , TSF participants were abstinent 16.1 % more days than MET participants . At the lower end of this variable , difference in percent days abstinent between MET and TSF was 3 % , with MET clients having more abstinent days . A significant matching effect for psychiatric severity that appeared in the first year posttreatment was not observed after 3 years . Of the 21 client attributes used in testing the matching hypotheses , 11 had prognostic value at 3 years . Among these , readiness-to-change and self-efficacy emerged as the strongest predictors of long-term drinking outcome . With regard to the overall outcomes , the reductions in drinking that were observed in the first year after treatment were sustained over the 3-year follow-up period : almost 30 % of the subjects were totally abstinent in months 37 to 39 , whereas those who did report drinking nevertheless remained abstinent an average of two-thirds of the time . As in the 1-year follow-up , there were few differences among the three treatments , although TSF continued to show a possible slight advantage BACKGROUND In 2001 , the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments ( CANMAT ) partnered to produce evidence -based clinical guidelines for the treatment of depressive disorders .  A revision of these guidelines was undertaken by CANMAT in 2008 - 2009 to reflect advances in the field . This article , one of five in the series , review s new studies of psychotherapy in the acute and maintenance phase of MDD , including computer-based and telephone-delivered psychotherapy . METHODS The CANMAT guidelines are based on a question -answer format to enhance accessibility to clinicians . Evidence -based responses are based on up date d systematic review s of the literature and recommendations are grade d according to the Level of Evidence , using pre-defined criteria . Lines of Treatment are identified based on criteria that included evidence and expert clinical support . RESULTS Cognitive-Behavioural Therapy ( CBT ) and Interpersonal Therapy ( IPT ) continue to have the most evidence for efficacy , both in acute and maintenance phases of MDD , and have been studied in combination with antidepressants . CBT is well studied in conjunction with computer-delivered methods and bibliotherapy . Behavioural Activation and Cognitive-Behavioural Analysis System of Psychotherapy have significant evidence , but need replication . Newer psychotherapies including Acceptance and Commitment Therapy , Motivational Interviewing , and Mindfulness-Based Cognitive Therapy do not yet have significant evidence as acute treatments ; nor does psychodynamic therapy . LIMITATIONS Although many forms of psychotherapy have been studied , relatively few types have been evaluated for MDD in r and omized controlled trials . Evidence about the combination of different types of psychotherapy and antidepressant medication is also limited despite widespread use of these therapies concomitantly . CONCLUSIONS CBT and IPT are the only first-line treatment recommendations for acute MDD and remain highly recommended for maintenance . Both computer-based and telephone-delivered psychotherapy -- primarily studied with CBT and IPT -- are useful second-line recommendations . Where feasible , combined antidepressant and CBT or IPT are recommended as first-line treatments for acute MDD Over 50 % of people with a severe mental illness also use illicit drugs and /or alcohol at hazardous levels . This review is based on the findings of 25 r and omized controlled trials which assessed the effectiveness of  psychosocial interventions , offered either as one-off treatments or as an integrated or nonintegrated program , to reduce substance use by people with a severe mental illness . The findings showed that there was no consistent evidence to support any one psychosocial treatment over another . Differences across trials with regard to outcome measures , sample characteristics , type of mental illness and substance used , setting s , levels of adherence to treatment guidelines , and st and ard care all made pooling results difficult . More quality trials are required that adhere to proper r and omization methods ; use clinical ly valuable , reliable , and vali date d measurement scales ; and clearly report data , including retention in treatment , relapse , and abstinence rates . Future trials of this quality will allow a more thorough assessment of the efficacy of psychosocial interventions  for reducing substance use in this challenging population This study examines the linkages in the treatment process chains that are thought to underlie two prevalent approaches to substance abuse treatment , traditional 12-Step treatment and cognitive-behavioral treatment . The focus is on the " proximal outcomes " specified by the two treatment approaches and their relation to " ultimate " substance use outcomes assessed at a 1-year follow-up . A total of 2687 men who received treatment in 15 Department of Veterans Affairs substance abuse treatment programs were assessed at treatment entry , at or near discharge , and at a 1-year follow-up . Based on the results of factor analyses , composite proximal outcomes variables were constructed to assess 1 
    Output:
    
There is strong evidence that some , but not all , psychosocial treatments are effective in treating alcohol problems .
Those with the strongest empirical support are motivational enhancement therapy , various cognitive-behavioural interventions , and brief interventions .
When these modalities have been compared with one another in well- design ed clinical trials , they have been shown to be of comparable effectiveness .