***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: Several studies have established that the personal and social consequences of substance abuse are extensive and costly . These consequences are frequently compounded by mental illness . Although interventions that target mentally ill chemical abusers ( MICAs ) present several challenges , the potential benefits of successful interventions are significant . This article presents outcomes and costs of a modified therapeutic community ( TC ) intervention for homeless MICAs . Outcomes at follow-up are compared with those for a control group of homeless MICAs receiving st and ard services in a “ treatment-as-usual ” ( TAU ) condition .  Annual economic costs for the modified TC and the average weekly cost of treating a single client are estimated . Treatment and other health service costs at 12 months postbaseline are compared for modified TC and TAU clients . The results of this study indicate that , suitably modified , the TC approach is an effective treatment alternative for homeless MICAs , with the potential to be highly cost-effective relative to st and ard services Investigators examined the 6-month impact of three cognitive-behavioral HIV risk-reduction programs on behavioral factors ( substance use and sexual risk behaviors ) and cognitive and psychological re sources of 325 women who resided in emergency or sober-living shelters and their 308 intimate sexual partners . Participants were r and omized by shelter to a peer-mentored , a nurse case-managed , or a st and ard care HIV risk-reduction program . Significant improvements were observed in all groups in all behavioral factors and cognitive and psychological re sources except for self-esteem . Participants in the peer-mentored and nurse case-managed groups did not differ significantly from the st and ard group in self-esteem , life satisfaction , psychological well-being , use of noninjection drugs , sex with multiple partners , and unprotected sex at 6 months ( n = 633 ) . It was concluded that a st and ard approach by health care professionals appears to effectively modify HIV risk behaviors for a majority of homeless participants and may have important economic and policy implication s. Further , the impact of short-term programs that address psychological vulnerabilities of impoverished population s needs to be studied further CONTEXT Many studies have shown a high prevalence of sexually transmitted diseases , human immunodeficiency virus ( HIV ) infection , viral hepatitis , drug dependence , and mental health problems among street youth . However , data on mortality among these youth are sparse . OBJECTIVES To estimate mortality rate among street youth in Montreal and to identify causes of death and factors increasing the risk of death . DESIGN , SETTING , AND POPULATION From January 1995 to September 2000 , 1013 street youth 14 to 25 years of age were recruited in a prospect i ve cohort with semi-annual follow-ups . Original study objectives were to determine the incidence and risk factors for HIV infection in that population ; however , several participants died during the first months of follow-up , prompting investigators to add mortality to the study objectives . Mortality data were obtained from the coroner 's office and the Institut de la Statistique du Québec . MAIN OUTCOME MEASURES Mortality rate among participants and factors increasing the risk of death . RESULTS Twenty-six youth died during follow-up for a mortality rate of 921 per 100 000 person-years ( 95 % confidence interval [ CI ] , 602 - 1350 ) ; this represented a st and ardized mortality ratio of 11.4 . The observed causes of death were as follows : suicide ( 13 ) , overdose ( 8) , unintentional injury ( 2 ) , fulminant hepatitis A ( 1 ) , heart disease ( 1 ) ; 1 was unidentified . In multivariate Cox regression analyses , HIV infection ( adjusted hazard ratio [ AHR ] = 5.6 ; 95 % CI , 1.9 - 16.8 ) , daily alcohol use in the last month ( AHR = 3.2 ; 95 % CI , 1.3 - 7.7 ) , homelessness in the last 6 months ( AHR = 3.0 ; 95 % CI , 1.1 - 7.6 ) , drug injection in the last 6 months ( AHR = 2.7 ; 95 % CI , 1.2 - 6.2 ) , and male sex ( AHR = 2.6 ; 95 % CI , 0.9 - 7.7 ) were identified as independent predictors of mortality . CONCLUSIONS Current heavy substance use and homelessness were factors associated with death among street youth .  HIV infection was also identified as an important predictor of mortality ; however , its role remains to be clarified . These findings should be taken into account when developing interventions to prevent mortality among street youth OBJECTIVE Intense debate exists concerning the number of homeless people in the United States . Previous studies , counting currently homeless people , have provided point-prevalence estimates of homelessness but have been criticized on method ological grounds . This study reports lifetime and 5-year prevalence estimates of homelessness using a different method ological approach . METHODS R and om-digit dialing was used to interview  1507 adults living in households with telephones in the 48 contiguous states in the fall of 1990 . Respondents were asked whether they had ever been homeless and if so , where they had slept while homeless . RESULTS Lifetime and 5-year prevalence of all types of homelessness combined were 14.0 % ( 26 million people ) and 4.6 % ( 8.5 million people ) , respectively . Lifetime " literal homelessness " ( sleeping in shelters , ab and oned buildings , bus and train stations , etc . ) was 7.4 % ( 13.5 million people ) . Five-year ( 1985 through 1990 ) prevalence of self-reported homelessness among those who had ever been literally homeless was 3.1 % ( 5.7 million people ) . CONCLUSIONS The magnitude of the problem of homelessness is much greater than most previous attempts to enumerate homeless people have led us to believe . This finding requires reconsideration of inferences about the causes of homelessness that were derived from point-prevalence studies of currently homeless people Project H&ART was a r and omized intervention trial for homeless alcohol abusers in Albuquerque , N.M. Interventions were four months in duration and included : a high intensity program ( case management plus peer-supervised housing ) , a medium intensity group ( peer-supervised housing only ) ; a housed , and a nonhoused control group .  Clients were interviewed at baseline and re-interviewed ten months following program entry to determine substance use , housing stability and employment status . Program graduation rates were about 25 % for the three housed groups . The outcome evaluation revealed significant within groups improvements in all of the outcomes , no between groups or racial outcome differences , and more favorable alcohol use and housing stability outcomes among program graduates than dropouts . On follow-up , women in the study had fewer days of alcohol use and had more days of stable housing , but were less likely to be employed , compared with men . We suggest that clients ' personal motivation for recovery , rather than program-related factors , were most influential in determining outcomes OBJECTIVES This study tested a psychiatric rehabilitation approach for organizing and delivering services to street-dwelling persons with severe mental illness . METHODS Street-dwelling persons with severe mental illness were r and omly assigned to the experimental program ( called Choices ) or to  st and ard treatment in New York City . We assessed study participants at baseline and at 6-month intervals over 24 months , using measures of service use , quality of life , health , mental health , and social psychological status . The average deviation from baseline summary statistic was employed to assess change . RESULTS Compared with persons in st and ard treatment ( n = 77 ) , members of the experimental group ( n = 91 ) were more likely to attend a day program ( 53 % vs 27 % ) , had less difficulty in meeting their basic needs , spent less time on the streets ( 55 % vs 28 % reduction ) , and spent more time in community housing ( 21 % vs 9 % increase ) . They showed greater improvement in life satisfaction and experienced a greater reduction in psychiatric symptoms . CONCLUSIONS With an appropriate service model , it is possible to engage disaffiliated population s , exp and their use of human services , and improve their housing conditions , quality of life , and mental health status Smoking treatment for newly recovering drug and alcohol-dependent smokers in a residential rehabilitation program was examined . The r and omly assigned conditions ( n = 50 each ) were multicomponent smoking treatment ( MST ) , MST plus generalization training of smoking cessation to drug and alcohol cessation ( MST+G ) , or usual care ( UC ) .  Fifty participants who declined smoking treatment ( treatment refusers ) also were studied . Both treatment conditions achieved continuous smoking abstinence rates ( MST : 12 % , MST+G : 10 % , at 12-month follow-up ) that were significantly higher than in the UC condition ( 0 % ) . The MST condition had a continuous drug and alcohol abstinence rate that was significantly higher than that of the MST+G condition ( 40 % vs. 20 % at 12-month follow-up ) although neither differed significantly from that of the UC condition ( 33 % ) . These results support the feasibility of smoking treatment for this population and provide information regarding appropriate treatment components BACKGROUND Supported housing , integrating clinical and housing services , is a widely advocated intervention for homeless people with mental illness . In 1992 , the US Department of Housing and Urban Development ( HUD ) and the US Department of Veterans Affairs ( VA ) established the HUD-VA Supported Housing ( HUD-VASH ) program . METHODS Homeless veterans with psychiatric and /or substance abuse disorders or both ( N = 460 ) were r and omly assigned to 1 of 3 groups : ( 1 ) HUD-VASH , with Section 8 vouchers ( rent subsidies ) and intensive case management ( n = 182 ) ; ( 2 ) case management only , without special access to Section 8 vouchers ( n = 90 ) ; and ( 3 )  st and ard VA care  ( n = 188 ) Primary outcomes were days housed and days homeless . Secondary outcomes were mental health status , community adjustment , and costs from 4 perspectives . RESULTS During a 3-year follow-up , HUD-VASH veterans had 16 % more days housed than the case management-only group and 25 % more days housed than the st and ard care group ( P<.001 for both ) . The case management-only group had only 7 % more days housed than the st and ard care group ( P = .29 ) . The HUD-VASH group also experienced 35 % and 36 % fewer days homeless than each of the control groups ( P<.005 for both ) . There were no significant differences on any measures of psychiatric or substance abuse status or community adjustment , although HUD-VASH clients had larger social networks . From the societal perspective , HUD-VASH was 6200 US dollars ( 15 % ) more costly than st and ard care . Incremental cost-effectiveness ratios suggest that HUD-VASH cost 45 US dollars more than st and ard care for each additional day housed ( 95 % confidence interval , -19 US dollars to 108 US dollars ) . CONCLUSIONS Supported housing for homeless people with mental illness results in superior housing outcomes than intensive case management alone or st and ard care and modestly increases societal costs 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 The present study was design ed to explore the relative efficacy of three types of service delivery intervention models for homeless men with alcohol and /or drug problems :  integrated comprehensive residential services provided at one site ( Group 1 ) ; on-site shelter-based intensive case management with referrals to a community network of services ( Group 2 ) ; and usual care shelter services with case management ( Group 3 ) . In addition to assessing the relative efficacy of these approaches in terms of drug and alcohol use , residential stability , economic and employment status , the project also sought to examine what personal factors best predicted successful outcomes for clients . Clients were assessed at baseline and approximately six months following discharge . All three treatment groups improved significantly over time in terms of reduced alcohol and cocaine use , increased employment , and increased stable housing , but no differential improvement was found among groups . Successful outcomes were predicted by lower recent and lifetime substance use , fewer prior treatment episodes , more stable housing at baseline , fewer incarcerations , and less social isolation OBJECTIVE Reductions in runaways ' sexual risk behaviors were evaluated in response to an intensive program to prevent human immunodeficiency virus ( HIV ) infection and the acquired immunodeficiency syndrome ( AIDS ) . DESIGN In a nonr and omized control trial , sexual risk behaviors among 78 runaways at one residential shelter who received up to 30 HIV/AIDS intervention sessions  were compared with 67 runaways at a nonintervention shelter with sexual behaviors assessed at baseline and 3 and 6 months . SETTING Runaways were recruited from the only two publicly funded shelters in New York , NY . PARTICIPANTS The runaways were aged 11 to 18 years , 64 % female , 
    Output:
    
For homeless people with mental illness , case management linked to other services was effective in improving psychiatric symptoms , and assertive case management was effective in decreasing psychiatric hospitalizations and increasing outpatient contacts .
For homeless people with substance abuse problems , case management result ed in greater decreases in substance use than did usual care .
For homeless people with latent tuberculosis , monetary incentives improved adherence rates .
Although a number of studies comparing an intervention to usual care were positive , studies comparing two interventions frequently found no significant difference in outcomes .
CONCLUSIONS Coordinated treatment programs for homeless adults with mental illness or substance abuse usually result in better health outcomes than usual care .