***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: Summary The comparative effects of alcoholism treatment programmes were examined by r and omly assigning 113 male and female detoxified alcoholics to either : a 6-week inpatient programme , a 6-week outpatient programme or a single confrontational interview . On a variety of outcome measures , that included both levels of drinking and general functioning taken 6 and 18 months after intake , no treatment appeared to be consistently more effective than another . Furthermore , those who stayed in treatment did not show significantly more long-term improvement than those who refused or dropped out of treatment . Abstinent subjects felt more often than drinkers that they had achieved the goals they had set themselves and by the final follow-up there were many positive differences in apparent lifestyle . Although individual drinking patterns were unstable , on average , almost half the subjects located had either abstained or were drinking moderately . Patient and treatment variables combined explained up to 57 % of the variance in amount drunk after treatment , with patient variables providing the strongest associations AIMS The present study aim ed to evaluate whether individual counselling for alcohol-dependent patients in three sessions is as effective as a 2-week group treatment programme as part of an in-patient stay in a psychiatric hospital which was to foster motivation to seek further help and to strengthen the motivation to stay sober . Of particular importance was the external validity of the results , i.e. a ' normal ' intake load of in- patients in detoxification and a wide variety of motivation to stop drinking were to be investigated . METHODS Subjects eligible for the study were all patients with alcohol problems admitted to a psychiatric hospital , but without psychosis , as the main diagnosis , and with a maximum of 10 detoxification treatments in the past . A r and omized-controlled trial was conducted with 161 alcohol-dependent in- patients who received three individual counselling sessions on their ward in addition to detoxification treatment and 161 in- patients who received 2 weeks of in-patient treatment and four out-patient group sessions in addition to detoxification .  Both interventions followed the principles and strategies of motivational interviewing . RESULTS Six months after intervention , group-treatment patients showed a higher rate of participation in self-help groups ; however , this difference had disappeared 12 months after treatment . The abstinence rate among the former patients did not differ between the two intervention groups . CONCLUSION Group treatment may lead to a higher rate of participation in self-help groups , but does not increase the abstinence rate 6 months after treatment BACKGROUND Individuals with comorbid substance use and posttraumatic stress disorder may differentially benefit from integrated trauma-focused interventions based on specific presenting characteristics such as substance use type and PTSD severity . The current study is a secondary analysis of a NIDA Clinical Trials Network study exploring the effectiveness of two interventions for women with comorbid PTSD and substance use disorders . METHOD Generalized estimating equations were used to examine the association of baseline alcohol misuse with PTSD outcome measures over time for all r and omized participants . RESULTS Women entering treatment with baseline alcohol misuse had higher Post Traumatic Stress Disorder Symptom Scale ( PSS-SR ) total scores ( t=2.43 , p<.05 ) , cluster C ( avoidance/numbing ) scores ( t=2.63 , p<.01 ) , and cluster D ( hyper-arousal ) scores ( t=2.31 , p<.05 ) . For women with alcohol misuse , after treatment week 1 , PSS-SR scores were significantly lower in the Seeking Safety intervention during treatment ( chi(2)(1)=4.00 , p<.05 ) and follow-up ( chi(2)(1)=4.87 , p<.05 ) compared to those in the health education intervention . Alcohol misusers in the Seeking Safety group who had higher baseline hyper-arousal severity improved more quickly than those with lower baseline hyper-arousal severity during treatment ( chi(2)(1)=4.06 , p<.05 ) . CONCLUSIONS These findings suggest that the type of substance abuse at treatment entry may inform treatment selection , predict treatment response among those with co-occurring PTSD and substance use disorders , and indicate a more severe clinical picture Background : People who are homeless and chronically alcoholic have increased health problems , use of emergency services and police contact , with a low likelihood of rehabilitation . Harm reduction is a policy to decrease the adverse consequences of substance use without requiring abstinence . The shelter-based Managed Alcohol Project ( MAP ) was created to deliver health care to homeless adults with alcoholism and to minimize harm ; its effect upon consumption of alcohol and use of crisis services is described as proof of principle . Methods : Subjects enrolled in MAP were dispensed alcohol on an hourly basis . Hospital charts were review ed for all emergency department ( ED ) visits and admissions during the 3 years before and up to 2 years after program enrolment , and the police data base was accessed for all encounters during the same periods . The results of blood tests were analyzed for trends . A question naire was administered to MAP participants and staff about alcohol use , health and activities of daily living before and during the program . Direct program costs were also recorded . Results : Seventeen adults with an average age of 51 years and a mean duration of alcoholism of 35 years were enrolled in MAP for an average of 16 months . Their monthly mean group total of ED visits decreased from 13.5 to 8 ( p = 0.004 ) ; police encounters , from 18.1 to 8.8 ( p = 0.018 ) . Changes in blood test findings were nonsignificant . All program participants reported less alcohol consumption during MAP , and subjects and staff alike reported improved hygiene , compliance with medical care and health . Interpretation : A managed alcohol program for homeless people with chronic alcoholism can stabilize alcohol intake and significantly decrease ED visits and police encounters The aim of this research was to evaluate the effectiveness of long-term brief intervention in routine general practice . In five primary care out-patient clinics in a Finnish town , 296 male early-phase heavy drinkers consulting a general practitioner ( GP ) for various reasons were identified . Control group C ( n = 88 ) was informed of the risks of drinking after the screening and were advised at the subsequent feedback about 2 weeks later to reduce their drinking . Groups A ( n = 109 ) and B ( n = 99 ) were offered in addition seven and three brief intervention sessions , respectively . All GPs took part , whether or not they indicated a special interest . The main outcome measures were differences between beginning and end-point at 3 years in self-reported alcohol consumption , mean corpuscular volume ( MCV ) , and serum carbohydrate-deficient transferrin , aspartate aminotransferase , alanine aminotransferase and gamma-glutamyltransferase . There were no statistically significant differences between study groups A , B and C in mean changes in outcome measures . Within all the groups , MCV decreased . Depending on the outcome measure used and the study group analysed , clinical ly significant reduction of drinking was found in 25 - 53 % of the subjects . In routine general practice , giving additional sessions of brief intervention may not be as effective as in special research conditions . Factors reducing the effectiveness of brief intervention programmes should be investigated , so that primary health care staff can be better supported in their efforts OBJECTIVES To characterize the homeless adult population of an urban emergency department ( ED ) and study the medical , psychiatric , and social factors that contribute to homelessness . METHODS A prospect i ve , case-control survey of all homeless adult patients presenting to an urban , tertiary care ED and a r and om set of non-homeless controls over an eight-week period during summer 1999 . Research assistants administered a 50-item question naire and were trained in assessing dentition and triceps skin-fold thickness . INCLUSION CRITERIA all homeless adults who consented to participate . Homelessness was defined as being present for any person not residing at a private address , group home , or drug treatment program . R and omly selected controls were concurrently enrolled with a 3:1 homeless : control rate . EXCLUSION CRITERIA critically ill , injured , or incapacitated patients , or patients < 21 years of age . Univariate analysis with appropriate statistical tests was used . The Mantel-Haenszel test was used to adjust for population differences . RESULTS Two hundred fifty-two homeless subjects and 88 controls were enrolled . Data are presented for homeless vs control patients , and all p-values were < 0.01 . Odds ratios ( ORs ) with 95 % confidence intervals ( 95 % CIs ) are given where appropriate : mean age ( + /-SD ) = 42 + /- 10 vs 48 + /- 13 ; male gender 95 % vs 54 % ( OR = 17 ; 95 % CI = 8 to 37 ) ; history of ( hx ) tuberculosis 49 % vs 15 % ( OR = 2.5 ; 95 % CI = 1.2 to 3 ) ; hx HIV infection 35 % vs 13 % ( OR = 3.8 ; 95 % CI = 1.8 to 8) ; hx penetrating trauma 62 % vs 16 % ( OR = 8.62 ; 95 % CI = 4.4 to 17.1 ) ; hx depression 70 % vs 15 % ( OR = 13.4 ; 95 % CI = 6.7 to 27 ) ; hx schizophrenia 27 % vs 7 % ( OR = 5.1 ; 95 % CI = 2.0 to 14 ) ; hx alcoholism 81 % vs 15 % ( OR = 24 ; 95 % CI = 12 to 49 ) ; significant tooth loss ( > 3 ) 43 % vs 18 % ( OR = 3.3 ; 95 % CI = 1.8 to 6.4 ) ; percentage of body fat 16.5 % vs 19.7 % ; hx social isolation ( no weekly social contacts ) 81 % vs 11 % ( OR = 33.3 ; 95 % CI = 14 to 100 ) ; mean number of ED visits/year 6.0 vs 1.6 . CONCLUSIONS In the study population homelessness was associated with a history of significantly higher rates of infectious disease , ethanol and substance use , psychiatric illness , social isolation , and rates of ED utilization Homeless shelters provide a unique opportunity to intervene with occupants who have substance abuse problems , as not addressing these issues may lead to continuation of problems playing a contributing role in homelessness . Attempts to implement Contingency Management ( CM ) with this population have often been complex , costly , and not straightforward to replicate in community setting s. We conducted a r and omized trial evaluating a simple , low-cost 4-week CM program for 30 individuals seeking shelter in a community-based homeless shelter who had both current substance and psychiatric disorders .  Behavioral assessment s were performed at baseline , weekly , and termination of the study . Overall retention in the trial was high ; participants assigned to CM reduced their cocaine and alcohol use more than those in assessment -only . This pilot trial suggests that application of low-cost CM procedures is feasible within this novel setting and may decrease substance use AIMS Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone . The present study ( Depression and Alcohol Integrated and Single-focused Interventions ; DAISI ) aim ed to compare the effectiveness of brief intervention , single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems . METHODS Participants ( n = 284 ) with current depressive symptoms and hazardous alcohol use were assessed and r and omly allocated to one of four individually delivered interventions : ( i ) a brief intervention only ( single 90-minute session ) with an integrated focus on depression and alcohol , or followed by a further nine 1-hour sessions with ( ii ) an alcohol focus ; ( iii ) a depression focus ; or ( iv ) an integrated focus . Follow-up assessment s occurred 18 weeks after baseline . RESULTS Compared with the brief intervention , 10 sessions were associated with greater reductions in average drinks per week , average drinking days per week and maximum consumption on 1 day . No difference in duration of treatment was found for depression outcomes . Compared with single-focused interventions , integrated treatment was associated with a greater reduction in drinking days and level of depression .  For men , the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning .  Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment . CONCLUSIONS Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems , at least in the short term . Gender differences between single-focused depression and alcohol treatments warrant further study OBJECTIVE This study compared two different implementation strategies for Cutting Back , a primary care alcohol screening and brief intervention ( SBI ) program  for hazardous and harmful drinkers . It also identified organizational factors contributing to the success or failure of SBI implementation . METHOD Cutting Back was implemented in 10 primary care practice s associated with managed care organizations ( MCOs ) in five states , through a system of planning , training , technical assistance and clinic feedback . Clinics were r and omly assigned to one of two brief intervention systems : In the P Model , medical providers were responsible for delivering interventions , whereas in the S Model mid-level professionals ( usually nurses ) acted as the clinic specialists to provide that service . Data were collected to measure the performance of screening and delivery of interventions in each clinic . RESULTS The S Model screened a higher percentage of patients than did the P 
    Output:
    
These results accurately reflect the use of MAPs in current practice as existing programmes are ongoing only in a small number of sample pilot projects that target individuals with severe alcohol dependence or who consume non-beverage alcohol .
AUTHORS ' CONCLUSIONS The lack of evidence does not allow for a conclusion regarding the efficacy of MAP on their own , or as compared to brief intervention , moderate drinking , no intervention or 12-step variants .
It is the review authors ' opinion that it is likely to be the objective of MAPs that reduce their reportability and use in current practice , rather than a failure to provide an intervention that reduces the effects of alcohol dependence .
Aim ing to reduce harmful or antisocial behaviour in vulnerable individuals through the regulation of daily alcohol intake , rather than reducing harmful alcohol intake over time , provides considerable difficulty in developing measures of success from self-reported data ( low treatment thresholds ) , monitoring long-term efficacy or establishing causal links between programme admission and a reduction in targeted behaviours , owing to the fact that prolonged participation in the programme is likely to indicate a willingness in the individual to change their behaviour patterns .