***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: Objectives The purpose of this study was to explore the efficacy in a primary care setting of a telephone-based disease management program for the acute management of depression and /or at-risk drinking . Material s and Methods Veterans ( N = 97 ) with depression and /or at-risk drinking were identified by systematic screening and assessment . Eligible subjects received either telephone disease management ( TDM ) program or usual care based on r and om assignment of their clinician . The TDM program consisted of regular contacts with each subject by a behavioral health specialist ( BHS ) to assist in assessment , education , support , and treatment planning . Symptomatic outcomes were assessed at 4 months . Results Overall response rates favored those assigned to TDM compared with those assigned to usual care ( 39.1 % responded vs. 17.6 % , p = 0.022 ) . Response rates within the separate diagnostic groups also favored TDM , but this was only significant for depressive disorders . Conclusions Although the sample size was modest and the sample was limited to veterans , findings strongly suggest that a telephone-based disease management program can improve outcomes for patients with a behavioral health problem . Findings also suggest that a health specialist can focus and manage patients with different diagnoses , thus exp and ing the role beyond just depression care . TDM may be a viable , low-cost , model for primary care clinicians to deliver manual guideline -adherent behavioral health care , especially in a VA clinical setting OBJECTIVE A previous pilot study found positive outcomes among alcohol-dependent individuals with elevated depressive symptoms who received cognitive-behavioral treatment for depression ( CBT-D ; n = 19 )  compared with a relaxation training control ( RTC ; n = 16 ) . The current study represents a replication of this pilot study using a larger sample size and a longer follow-up assessment period . METHOD Patients entering a partial hospital drug and alcohol treatment program who met criteria for alcohol dependence and elevated depressive symptoms ( Beck Depression Inventory score ≥ 15 ) were recruited and r and omly assigned to receive eight individual sessions of CBT-D ( n = 81 ) or RTC ( n = 84 ) . RESULTS There were significant improvements in depressive and alcohol use outcomes over time for all participants .Compared with RTC , the CBT-D condition had significantly lower levels of depressive symptoms , as measured by the Beck Depression Inventory , at the 6-week follow-up . However , this effect was inconsistent because there were no differences in the Modified Hamilton Rating Scale for Depression between conditions at that time point and there were no significant differences at any other follow-up . No significant between-group differences on alcohol use outcomes were found . CONCLUSIONS The current findings did not replicate the positive outcomes observed in the CBT-D condition in our previous pilot study . Possible explanations for why these findings were not replicated are discussed , as are theoretical and clinical implication s of using CBT-D in alcohol treatment AIMS This study examines the impact of comorbid Diagnostic and Statistical Manual version IV ( DSM-IV ) anxiety and /or depression on  out-patient treatment for alcohol problems .  DESIGN A prospect i ve correlational design . PARTICIPANTS AND SETTING S Seventy-one clients seeking alcohol out-patient treatment at two treatment sites were interviewed at commencement of a treatment episode for alcohol problems and reinterviewed using the same measures 3 months later . Comorbid DSM-IV anxiety and /or depression were measured by the Composite International Diagnostic Interview ( CIDI ) , a comprehensive interview developed by the World Health Organization to assess current and life-time prevalence of mental disorders . Outcome measures included st and ardized measures of disability [ the short form (SF)-12 Mental Health Summary Score and the number of days taken out of role ] and the average amount of alcohol consumed . Clients were also asked to rate their satisfaction with the services received . FINDINGS Participants with comorbid DSM-IV anxiety and /or depressive disorders were more disabled and drank more heavily than those without these comorbid disorders at entry to treatment . At 3-month follow-up both groups of participants ( i.e. those with and without DSM-IV comorbid anxiety and /or depression ) were significantly less disabled and also drank significantly less alcohol on an average drinking occasion than at baseline . Despite this , the comorbid group remained more disabled and drank more heavily than the non-comorbid group at follow-up . CONCLUSIONS Further research is needed to determine the most appropriate model of care for alcohol treatment seekers with comorbid DSM-IV anxiety and /or depression Alcoholics with depressive symptoms score > or = 10 on the Beck Depression Inventory ( A.T. Beck , C. H. Ward , M. Mendelson , J. Mock , & J. Erbaugh , 1961 ) received 8 individual sessions of cognitive-behavioral treatment for depression ( CBT-D , n = 19 )  or a relaxation training control ( RTC ; n = 16 ) plus st and ard alcohol treatment . CBT-D patients had greater reductions in somatic depressive symptoms and depressed and anxious mood than RTC patients during treatment . Patients receiving CBT-D had a greater percentage of days abstinent but not greater overall abstinence or fewer drinks per day during the first 3-month follow-up . However , between the 3- and 6-month follow-ups , CBT-D patients had significantly better alcohol use outcomes on total abstinence ( 47 % vs. 13 % ) , percent days abstinent ( 90.5 % vs. 68.3 % ) , and drinks per day ( 0.46 vs. 5.71 ) . Theoretical and clinical implication s of using CBT-D in alcohol treatment are discussed 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 CONTEXT Although depression frequently co-occurs with substance abuse , few individuals entering substance abuse treatment have access to effective depression treatment . OBJECTIVE The Building Recovery by Improving Goals , Habits , and Thoughts ( BRIGHT ) study is a community-based effectiveness trial that compared residential substance abuse treatment with residential treatment plus group cognitive behavioral therapy for depression delivered by substance abuse treatment counselors . We hypothesized that intervention clients would have improved depression and substance use outcomes compared with those of clients receiving usual care . DESIGN A nonr and omized controlled trial using a quasi-experimental intent-to-treat design in which 4 sites were assigned to alternate between the intervention and usual care conditions every 4 months for 2½ years . SETTING Four treatment programs in Los Angeles County . PARTICIPANTS We screened 1262 clients for persistent depressive symptoms ( Beck Depression Inventory-II score > 17 ) . We assigned 299 clients to receive either usual care ( n = 159 ) or usual care plus the intervention ( n = 140 ) . Follow-up rates at 3 and 6 months after the baseline interview were 88.1 % and 86.2 % , respectively , for usual care and 85.7 % and 85.0 % , respectively , for the intervention group . INTERVENTION Sixteen 2-hour group sessions of cognitive behavioral therapy for depression . MAIN OUTCOME MEASURES Change in depression symptoms , mental health functioning , and days of alcohol and problem substance use . RESULTS Intervention clients reported significantly fewer depressive symptoms ( P < .001 at 3 and 6 months ) and had improved mental health functioning ( P < .001 at 3 months and P < .01 at 6 months ) . At 6 months , intervention clients reported fewer drinking days ( P < .05 ) and fewer days of problem substance use ( P < .05 ) on days available . CONCLUSIONS Providing group cognitive behavioral therapy for depression to clients with persistent depressive symptoms receiving residential substance abuse treatment is associated with improved depression and substance use outcomes . These results provide support for a new model of integrated care . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01191788 UNLABELLED College is a time of increased risk for problematic alcohol use and depressed mood . The comorbidity of these conditions is well documented , but is less well understood , with few interventions design ed to prevent or reduce the related consequences . The current study evaluated a web-based personalized intervention for students ( N=311 ) who reported an AUDIT score of 8 or more , a BDI-II score of 14 or more , and reported drinking four ( women ) or five ( men ) or more drinks on at least one occasion in the past month . METHOD Invited participants were r and omly selected from all enrolled undergraduates at a large , public , Pacific Northwestern University . Participants completed a screening and baseline assessment , and those who met study eligibility criteria were r and omized to one of four conditions ( alcohol only , depressed mood only , integrated , and referral-only control ) . Follow-up occurred one-month post-intervention . RESULTS While no main effects for the interventions were found , there were moderation effects , such that students in the alcohol only and integrated conditions who had lower levels of depressed mood or alcohol-related problems at baseline showed greater reductions in alcohol-related problems at follow-up compared to students in the control condition . Implication s for interventions are discussed AIM To assess the effectiveness of a 12 week specialized , integrated intervention for alcohol dependence with comorbid anxiety and /or mood disorder using a r and omized design in an outpatient hospital setting . METHODS Out of 86 patients meeting the inclusion criteria for alcohol dependence with suspicion of comorbid anxiety and /or depressive disorder , 57 completed a 3-week stabilization period ( abstinence or significantly reduced consumption ) . Of these patients , 37 ( 65 % ) met a formal diagnostic assessment of an anxiety and /or depressive disorder and were r and omized to either ( a ) integrated intervention ( cognitive behavioural therapy ) for alcohol , anxiety and /or depression , or ( b ) usual counselling care for alcohol problems . RESULTS Intention-to-treat analyses revealed a beneficial treatment effect of integrated treatment relative to usual counselling care  for the number of days to relapse ( χ(2 ) = 6.42 , P < 0.05 ) and lapse ( χ(2 ) = 10.73 , P < 0.01 ) . In addition , there was a significant interaction effect of treatment and time for percentage days of abstinence ( P < 0.05 ) . For heavy drinking days , the treatment effect was mediated by changes in DASS anxiety ( P < 0.05 ) . There were no significant treatment interaction effects for DASS depression or anxiety symptoms . CONCLUSIONS These results provide support for integrated care in improving drinking outcomes for patients with alcohol dependence and comorbid depression/anxiety disorder . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT01941693 Brief interventions are effective for  problem drinking  and reductions are known to occur in association with screening and assessment . The present study sought to assess , among participants ( N=202 ) in a clinical trial , how much change occurred between baseline assessment and a one-session brief intervention ( S1 ) , and the predictors of early change . The primary focus was on changes in the Beck Depression Inventory Fast Screen scores and alcohol consumption ( st and ard drinks per week ) prior to r and om allocation to nine further sessions addressing either depression , alcohol , or both problems . There were large and clinical ly significant reductions between baseline and S1 , with the strongest predictors being baseline scores in the relevant domain and change in the other domain . Client engagement was also predictive of early depression changes . Monitoring progress in both domains from first contact , and provision of empathic care , followed by brief intervention appear to be useful for this high prevalence comorbidity Integrated psychological treatment addressing co-existing alcohol misuse and depression has not been compared with single-focused treatment . This trial evaluates changes over 36 months following r and omization of 284 out patients to one of four motivational interviewing and cognitive-behavior therapy ( MICBT ) based interventions : ( 1 ) brief integrated intervention ( BI ) ; or BI plus 9 further sessions with ( 2 ) an integrated- 
    Output:
    
Therefore , while international guidelines recommend integrated dual-focussed treatment for co-occurring conditions , there is little evidence supporting the superiority of this treatment format for co-occurring alcohol misuse and depression .