***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: We recently concluded the third decade of large-scale public funding for  community-based drug abuse treatment in the United States . Over these years , basic and applied research in this arena has been carried out and reported at an unprecedented rate , based in part on the requirements of federal agencies to evaluate the effectiveness of our national drug abuse treatment system . Beginning in the early 1970s with the Drug Abuse Reporting Program ( DARP ) , followed by the Treatment Outcome Prospect i ve Study ( TOPS ) a decade later , and continuing through the 1990s with the Drug Abuse Treatment Outcome Studies ( DATOS ) , national evaluations have examined over 65,000 admissions to 272 treatment programs using multimodality and multisite sampling plans that allow the study of treatment in natural setting s. These national projects comprise only part of the large body of evidence accumulated over the past 30 years that supports the general effectiveness of drug treatment.1 - Integrated mental health and substance abuse treatment within an assertive community treatment ( ACT ) approach was compared to that within a st and ard case management approach for 223 patients with dual disorders over three years . ACT patients showed greater improvements on some measures of substance abuse and quality of life , but the groups were equivalent on most measures , including stable community days , hospital days , psychiatric symptoms , and remission of substance use disorder Jail recidivists with serious mental illness and substance use disorders were treated in an in-custody setting and then r and omly assigned to either a high fidelity Integrated Dual Disorders Treatment program  ( 103 participants )  or to service as usual  ( 79 participants ) . Outcomes were tracked an average of 18 months from program entry at the termination of the initial incarceration . A reduction in jail days from baseline to study period was significant for both groups . The pre to post reduction for arrests and total convictions was significant in the experimental group but not the control group . However , during the study period , differences between experimental and control groups in arrests , convictions and jail days were not statistically significant . Experimental participants had lower study period psychiatric inpatient and crisis utilization and greater outpatient utilization than did control group participants . The groups did not differ with regard to total institutional days . Experimental group attrition was relatively high BACKGROUND Few r and omised controlled trials have been aim ed specifically at substance use reduction among people with psychotic disorders . AIMS To investigate whether a 10-session intervention consisting of motivational interviewing and cognitive-behavioural therapy ( CBT ) was more efficacious than routine treatment in reducing substance use and improving symptomatology and general functioning . METHOD A community sample of people with a psychotic disorder and who reported hazardous alcohol , cannabis and /or amphetamine use during the preceding month was recruited . Participants were r and omly allocated to motivational interviewing/CBT ( n = 65 ) or treatment as usual ( n = 65 ) , and were assessed on multiple outcomes at baseline , 15 weeks , 6 months and 12 months . RESULTS There was a short-term improvement in depression and a similar trend with regard to cannabis use among participants who received the motivational interviewing/CBT intervention , together with effects on general functioning at 12 months . There was no differential benefit of the intervention on substance use at 12 months , except for a potentially clinical ly important effect on amphetamine use . CONCLUSIONS The motivational interviewing/CBT intervention was associated with modest improvements This study evaluated the efficacy of adding contingency management techniques to  vocational rehabilitation  ( VR ) to improve treatment outcome as measured by entry into competitive employment .  Nineteen dually diagnosed veterans who entered VR in the Veterans ' Administration 's compensated work therapy ( CWT ) program were r and omly assigned to CWT ( n = 8) or to CWT with enhanced incentives ( n = 11 ) . Over the first 16 weeks of rehabilitation , those in the incentives condition could earn up to dollar 1,006 in cash for meeting two sets of clinical goals : ( a ) remaining abstinent from drugs and alcohol and ( b ) taking steps to obtain and maintain a competitive job . Results indicate that relative to participants in the CWT-only group , those in the incentives condition engaged in more job- search activities , were more likely to remain abstinent from drugs and alcohol , were more likely to obtain competitive employment , and earned an average of 68 % more in wages . These results suggest that rehabilitation outcomes may be enhanced by restructuring traditional work-for-pay contingencies to include direct financial rewards for meeting clinical goals This study examined the effects of integrating mental health , substance abuse , and housing interventions for homeless persons with co-occurring severe mental illness and substance use disorder . With the use of a quasi-experimental design , integrated treatment was compared with st and ard treatment for 217 homeless , dually diagnosed adults over an 18-month period . The integrated treatment group had fewer institutional days and more days in stable housing , made more progress toward recovery from substance abuse , and showed greater improvement of alcohol use disorders than the st and ard treatment group . Abuse of drugs other than alcohol ( primarily cocaine ) improved similarly for both groups . Secondary outcomes , such as psychiatric symptoms , functional status , and quality of life , also improved for both groups , with minimal group differences favoring integrated treatment In adaptive treatment strategies , the treatment level and type is repeatedly adjusted according to ongoing individual response . Since past treatment may have delayed effects , the development of these treatment strategies is challenging . This paper advocates the use of sequential multiple assignment r and omized trials in the development of adaptive treatment strategies . Both a simple ad hoc method for ascertaining sample sizes and simple analysis methods are provided OBJECTIVE Comorbidity of substance abuse disorders with schizophrenia is associated with a greater risk for serious illness complications and poorer outcome . Method ologically sound studies investigating treatment approaches for patients with these disorders are rare , although recommendations for integrated and comprehensive treatment programs abound . This study investigates the relative benefit of adding an integrated psychological and psychosocial treatment program to routine psychiatric care for patients with schizophrenia and substance use disorders . METHOD The authors conducted a r and omized , single-blind controlled comparison of routine care with a program of routine care integrated with motivational interviewing , cognitive behavior therapy , and family or caregiver intervention . RESULTS The integrated treatment program result ed in significantly greater improvement in patients ' general functioning than routine care alone at the end of treatment and 12 months after the beginning of the study . Other benefits of the program included a reduction in positive symptoms and in symptom exacerbations and an increase in the percent of days of abstinence from drugs or alcohol over the 12-month period from baseline to follow-up . CONCLUSIONS These findings demonstrate the effectiveness of a program of routine care integrated with motivational interviewing , cognitive behavior therapy , and family intervention over routine psychiatric care alone for patients with comorbid schizophrenia and alcohol or drug abuse or dependence OBJECTIVES The feasibility and effectiveness of treating homeless mentally ill chemical abusers in community residences compared with a therapeutic community were evaluated . METHODS A total of 694 homeless mentally ill chemical abusers were r and omly referred to two community residences or a therapeutic community . All programs were enhanced to treat persons with dual diagnoses . Subjects ' attrition , substance use , and psychopathology were measured at two , six , and 12 months . RESULTS Forty-two percent of the 694 referred subjects were admitted to their assigned program and showed up for treatment , and 13 percent completed 12 months or more . Clients retained at both types of program showed reductions in substance use and psychopathology , but reductions were greater at the therapeutic community . Compared with subjects in the community residences , those in the therapeutic community were more likely to be drug free , as measured by urine analysis and self-reports , and showed greater improvement in psychiatric symptoms , as measured by the Center for Epidemiological Studies --Depression Scale and the Brief Psychiatric Rating Scale . Their functioning also improved , as measured by the Global Assessment of Functioning scale . CONCLUSIONS Homeless mentally ill chemical abusers who are retained in community-based residential programs , especially in therapeutic communities , can be successfully treated Homeless adults with both a serious mental illness and substance dependence ( N = 276 ) were r and omly assigned to : ( 1 ) a social model residential program providing integrated mental health and substance abuse treatment ; ( 2 ) a community-based nonresidential program using the same social model approach ; or ( 3 ) a control group receiving no intervention but free to access other community services . Interventions were design ed to provide 3 months of intensive treatment , followed by 3 months of nonresidential maintenance . Subjects completed baseline interviews prior to r and omization and reinterviews 3 , 6 , and 9 months later . Results showed that , while substance use , mental health , and housing outcomes improved from baseline , subjects assigned to treatment conditions differed little from control subjects . Examination of the relationship between length of treatment exposure and outcomes suggested that residential treatment had positive effects on outcomes at 3 months , but that these effects were eroded by 6 months BACKGROUND There is a well-recognized association between substance use and psychotic disorders , sometimes described as ' dual diagnosis ' . The use of substances by people with psychosis has a negative impact in terms of symptoms , longitudinal course of illness and psychosocial adjustment . There are few vali date d treatments for such individuals , and those that do exist are usually impracticable in routine clinical setting s. The present study employs a r and omized controlled experimental design to examine the effectiveness of a manualized group-based intervention in helping patients with dual diagnosis reduce their substance use . METHOD The active intervention consisted of weekly 90-min sessions over 6 weeks . The manualized intervention was tailored to participants ' stage of change and motivations for drug use . The control condition was a single educational session . RESULTS Sixty-three subjects participated , of whom 58 ( 92 % ) completed a 3-month follow-up assessment of psychopathology , medication and substance use . Significant reductions in favour of the treatment condition were observed for psychopathology , chlorpromazine equivalent dose of antipsychotics , alcohol and illicit substance use , severity of dependence and hospitalization . CONCLUSIONS It is possible to reduce substance use in individuals with psychotic disorders , using a targeted group-based approach . This has important implication s for clinicians who wish to improve the long-term outcome of their patients The effect of motivational interviewing on outpatient treatment adherence among psychiatric and dually diagnosed in patients was investigated . Subjects were 121 psychiatric in patients , 93 ( 77 % ) of whom had concomitant substance abuse/dependence disorders , who were r and omly assigned to : a ) st and ard treatment ( ST ) , including pharmacotherapy , individual and group psychotherapy , activities therapy , milieu treatment , and discharge planning ; or b ) ST plus motivational interviewing ( ST+MI ) , which involved 15 minutes of feedback on the results of a motivational assessment early in the hospitalization , and a 1-hour motivational interview just before discharge . Interviewers utilized motivational techniques described in Miller and Rollnick ( 1991 ) , such as reflective listening , discussion of treatment obstacles , and elicitation of motivational statements . Results indicated that the proportion of patients who attended their first outpatient appointment was significantly higher for the ST+MI group ( 47 % ) than for the ST group ( 21 % ; chi2 = 8.87 , df = 1 , p<.01 ) overall , and for dually diagnosed patients ( 42 % for ST+MI vs. 16 % for ST only ; chi2 = 7.68 , df = 1 , p<.01 ) . Therefore , brief motivational interventions show promise in improving outpatient treatment adherence among psychiatric and dually diagnosed patients OBJECTIVE Clients with co-occurring severe mental and substance use disorders are at high risk of institutionalization and other adverse outcomes . Although integrated mental health and substance abuse treatment is becoming a st and ard clinical approach for such clients , the optimal method for delivering integrated treatment remains unclear . METHOD This study compared integrated treatment delivered within two different models of community-based case management ( assertive community treatment and st and ard clinical case management ) .  A total of 198 clients in two urban sites who had co-occurring disorders and were homeless or unstably housed were r and omly assigned to one of two treatment conditions and were followed for three years . RESULTS Participants in both treatment conditions improved over time in multiple outcome domains , and few differences were found between the two models . Decreases in substance use were greater than would be expected given time alone . At the site that had higher rates of institutionalization , clients who received st and ard case management were more likely to be institutionalized . However , in the site that had lower rates of institutionalization , no differences in the rate of institutionalization were found between the two treatment conditions . CONCLUSIONS Integrated treatment can be successfully delivered either by assertive community treatment or by st and ard clinical case management OBJECTIVE Uncertainty regarding the degree to which persons with schizophrenia may lack decision-making capacity , and what the predictors of capacity may be led us to examine the relationship between psychopathology , neurocognitive functioning , and decision-making capacity in a large sample of persons with schizophrenia at entry into a clinical trial . METHOD In the Clinical Antipsychotic Trials of Intervention Effectiveness ( CATIE ) schizophrenia trial , a clinical trial sponsored by the National Institute of Mental Health design ed to compare the effectiveness of antipsychotic drugs , subjects were administered the MacArthur Competence Assessment Tool- Clinical Research ( MacCAT-CR ) and had to demonstrate adequate decision-making capacity before r and omization . The MacCAT-CR , the Positive and Negative Syndrome Scale ( PANSS ) , and an extensive neurocognitive battery were 
    Output:
    
Three types of interventions ( group counseling , contingency management , and residential dual diagnosis treatment ) show consistent positive effects on substance use disorder , whereas other interventions have significant impacts on other areas of adjustment ( e.g. , case management enhances community tenure and legal interventions increase treatment participation ) .