***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: OBJECTIVE This study examined 6-month treatment outcomes among 428 cocaine-dependent out patients with ( n = 34 ) and without ( n = 394 ) posttraumatic stress disorder ( PTSD ) in a r and omized controlled multisite clinical trial of manual-based psychotherapies for substance use disorder ( SUD ) . METHOD Assessment s were completed at baseline and monthly during the 6-month treatment . With longitudinal mixed-effects models , we compared outcomes between SUD-PTSD and SUD-only patients and also examined rates of within-group change . RESULTS Results indicated a highly consistent pattern : the SUD-PTSD patients were more impaired to begin with and remained so across time compared with SUD-only patients ( with the exception of substance use and addiction-related legal and employment problems , which did not differ between groups ) . Also , the SUD-PTSD patients improved less than SUD-only patients in alcohol use and the majority of addiction-related psychosocial problems . However , the two groups did not differ significantly in improvement over time on drug use or global psychological severity . CONCLUSIONS The greater impairment and relative lack of improvement of SUD-PTSD patients , compared with those with SUD-only , suggest a need for dual-diagnosis treatments that more directly target their areas of difficulty OBJECTIVE This study examined the prevalence of lifetime traumatic events and current symptoms of posttraumatic stress disorder ( PTSD ) among treatment-seeking cocaine-dependent out patients and compared patients with and without PTSD on current substance use , psychopathology , and sociodemographic characteristics . METHOD The subjects were 122 adult cocaine-dependent out patients participating in a treatment outcome study of psychosocial therapy .  In addition to st and ard self-report and interview measures of psychopathology and substance use , the subjects completed the Trauma History Question naire and the PTSD Checklist before entering treatment . RESULTS These patients experienced a large number of lifetime traumatic events ( mean = 5.7 ) ; men experienced more general disasters and crime-related traumas than women , and women experienced more physical and sexual abuse than men . According to self-report measures , 20.5 % of the subjects currently met the DSM-III-R criteria for PTSD ; the rate of PTSD was 30.2 % among women and 15.2 % among men . Patients with PTSD had significantly higher rates of co-occurring axis I and axis II disorders , interpersonal problems , medical problems , resistance to treatment , and psychopathology symptoms than patients without PTSD . Psychopathology symptoms represented the most consistent difference between the two groups and provided the best prediction of PTSD status in a logistic regression . However , the groups did not differ significantly in current substance use or sociodemographic characteristics . CONCLUSIONS These findings underscore the value of screening substance abusers for PTSD , because it can identify a small but substantial number who might require additional treatment . Further studies of the relationship between PTSD and substance abuse appear warranted 424 BMJ | 24 FEBRUARY 2007 | VOLUME 334 Almost all studies have some missing observations . Yet textbooks and software commonly assume that data are complete , and the topic of how to h and le missing data is not often discussed outside statistics journals . There are many types of missing data and different reasons for data being missing . Both issues affect the analysis . Some examples are : ( 1 ) In a postal question naire survey not all the selected individuals respond ; ( 2 ) In a r and omised trial some patients are lost to follow-up before the end of the study ; ( 3 ) In a multicentre study some centres do not measure a particular variable ; ( 4 ) In a study in which patients are assessed frequently some data are missing at some time points for unknown reasons ; ( 5 ) Occasional data values for a variable are missing because some equipment failed ; ( 6 ) Some laboratory sample s are lost in transit or technically unsatisfactory ; ( 7 ) In a magnetic resonance imaging study some very obese patients are excluded as they are too large for the machine ; ( 8) In a study assessing quality of life some patients die during the follow-up period The present study evaluated whether Posttraumatic Stress Disorder ( PTSD ) symptom severity was associated with participation and treatment outcomes comparing a Vipassana meditation course to treatment as usual in an incarcerated sample . This study utilizes secondary data . The original study demonstrated that Vipassana meditation is associated with reductions in substance use . The present study found that PTSD symptom severity did not differ significantly between those who did and did not volunteer to take the course . Participation in the Vipassana course was associated with significantly greater reductions in substance use than treatment as usual , regardless of PTSD symptom severity levels . These results suggest that Vipassana meditation is worthy of further study for those with comorbid PTSD and substance use problems The present study investigates the prevalence of comorbid posttraumatic stress disorder ( PTSD ) in a sample of Polish alcohol dependent patients and examines the relationship between comorbid PTSD and alcohol use-related problems . Patients ( n=458 ) were recruited from r and omly chosen clinical setting s and were administered self-report measures of trauma exposure , PTSD symptomatology , and alcohol use-related problems . From this sample , 67 % of the patients reported having experienced at least one criterion A traumatic event , and 60 % of them reported multiple traumas . Approximately 25 % of them met the criteria for current PTSD . The only significant difference between the PTSD and non-PTSD groups was abuse/dependence of other psychoactive substances . However , patients reporting physical assaults committed by a non-stranger reported more frequent PTSD diagnosis , more extensive symptomatology , more conflicts with the law and more physical injuries due to drinking . The findings of the study confirm the importance of assessing trauma and PTSD in alcohol dependent patients Psychological trauma and post-traumatic stress disorder ( PTSD ) may complicate and reduce the effectiveness of treatment for substance use disorders ( SUDs ) . This study assessed trauma history and symptoms of simple and complex PTSD at baseline in a r and omized trial of contingency management ( CM ) compared to st and ard treatment ( ST ) with 142 cocaine- or heroin-dependent out patients . History of exposure to each of eight types of psychological trauma was unrelated to treatment outcome , except for witnessed assaults and emotional abuse . Complex PTSD symptoms were inversely associated with short-term treatment outcomes , and PTSD symptoms were positively related to long-term outcome , independent of the effects of demographics , psychological distress , baseline substance use status , and treatment modality . Complex PTSD symptoms warrant further study as a potential negative prognostic factor in SUD interventions AIMS To assess the utility of biological testing in a general population survey for estimating prevalence and evaluating self-report data quality . DESIGN An audio computer-assisted interview was administered to subjects from June 2001 to January 2002 . Immediately following the interview , subjects were requested to participate in hair , oral fluid and urine testing . SETTING Subjects were from r and omly selected households in the City of Chicago using multi-stage sampling methods . Interviews were conducted in subjects ' homes . PARTICIPANTS The data represent 627 r and omly selected adult participants , ages 18 - 40 years . MEASUREMENTS Prevalance , kappa , conditioned kappa , sensitivity , specificity , under-reporting , ' mixed model ' and logistic regression . FINDINGS Higher rates of marijuana use were generated from survey reports than from drug testing . Drug testing generated higher prevalence rates than survey reports for recent use of cocaine and heroin . Under-reporting of recent drug use was apparent for all three substances . Sensitivity was particularly low for cocaine and heroin . Race was related to under-reporting , with African Americans less likely to report marijuana use despite a positive test result . CONCLUSIONS The utility of drug testing for surveys depends on the type of substance examined as well as on the type of test employed . Multiple tests have more utility than a single test . Drug testing is useful for identifying the levels and sources of under-reporting in a survey and provides a basis for adjusting prevalence estimates based on self-reports This study examined concurrent and prospect i ve associations between substance use disorder ( SUD ) and posttraumatic stress disorder ( PTSD ) diagnosis and symptoms and mechanisms underlying these associations . Participants ( n = 133 ) were assessed at intake and 6 months following inpatient SUD treatment . Patients differed by baseline PTSD status on psychiatric comorbidity and substance use history but not on current substance use symptoms . Participants with alcohol use disorders reported a greater number of reexperiencing symptoms . Baseline PTSD status did not predict substance use outcome . However , change in PTSD status over follow-up predicted substance use outcomes ; those with unremitted PTSD demonstrated poorer SUD outcome than those with remitted PTSD . General psychiatric distress at follow-up was associated with poorer outcomes , and such distress mediated the association between PTSD change status and substance use outcome . Findings suggest that clinicians should assess for PTSD among those with SUD and , during treatment , should monitor PTSD and other psychological symptoms , which may be risk factors for relapse to substance abuse Objective To present lifetime rates of service use  for psychological and substance use related problems among regular substance users and to examine factors associated with service use . Method Data come from a prospect ive-longitudinal , epidemiological study of a community sample of adolescents and young adults ( n = 2548 , age 14–24 years at baseline ) in Munich , Germany . The Munich-Composite International Diagnostic Interview ( M-CIDI ) was used at baseline and at two follow-ups to assess substance use and service use . Results Cumulated lifetime incidence of any substance abuse or dependence was 43.7 % . Of those with abuse and dependence 23 % had ever used any services for psychological or substance use related problems . Illicit substance users especially those with dependence had the highest rates of lifetime service use ( 52.1 % ) . Psychotherapists and counseling services were contacted most frequently among regular substance users over their lifetimes . Utlilisation rates of substance abuse services were low ( 2 % ) . Comorbid anxiety disorders and distressing life events were associated with increased lifetime service use . Conclusions Only a minority of adolescents and young adults with substance use disorders have ever sought professional help . Specialized substance abuse services play only a minor role . The core role of psychotherapists and non-substance abuse specialized services needs critical research attention . Linkages between psychotherapists and the substance use service system should be strengthened to detect and intervene at early developmental stages of abuse and dependence BACKGROUND Although disulfiram and naltrexone have been approved by the Food and Drug Administration for the treatment of alcoholism , the effect of these medications on alcohol use outcomes and on psychiatric symptoms is still unknown in patients with co-occurring disorders post-traumatic stress disorder ( PTSD ) . METHODS Patients ( n = 254 ) with a major Axis I psychiatric disorder and comorbid alcohol dependence were treated for 12 weeks in a medication study at three Veterans Administration outpatient clinics . R and omization included ( 1 ) open r and omization to disulfiram or no disulfiram ; and ( 2 ) double-blind r and omization to naltrexone or placebo . This result ed in four groups : ( 1 ) naltrexone alone ; ( 2 ) placebo alone ; ( 3 ) disulfiram and naltrexone ; or ( 4 ) disulfiram and placebo . Outcomes were measures of alcohol use , PTSD symptoms , alcohol craving , GGT levels and adverse events . RESULTS 93 individuals ( 36.6 % ) met DSM-IV criteria for PTSD . Subjects with PTSD had better alcohol outcomes with active medication ( naltrexone , disulfiram or the combination ) than they did on placebo ;  overall psychiatric symptoms of PTSD improved . Individuals with PTSD were more likely to report some side effects when treated with the combination . CONCLUSIONS The results of this study suggest that disulfiram and naltrexone are effective and safe for individuals with PTSD and comorbid alcohol dependence OBJECTIVE The purpose of this study was to determine whether opioid-dependent patients with diagnosed posttraumatic stress disorder ( PTSD ) have poorer long-term outcomes in opioid substitution treatment than do patients without PTSD . METHOD This prospect i ve observational study examined outcomes of 255 opioid-dependent patients ( men = 248 ) entering opioid substitution treatment at eight clinics in the Veterans Health Administration ( VHA ) . Subjects were interviewed at treatment entry , 6 months , and 1 year about substance use and related problems , health status , treatment satisfaction , and non-VHA health care utilization . Medical records were review ed to obtain toxicology results , health care utilization data , and diagnoses . Medical record review identified a diagnosis of PTSD in 71 ( 28 % ) patients . Substance-use and mental-health outcomes and health care utilization in the first year following treatment entry were compared between patients with and without a diagnosis of PTSD . RESULTS Patients with and without PTSD had similar treatment responses . Although patients with PTSD had longer histories of drug use at intake , at 1-year follow-up they showed reductions in heroin , cocaine , and alcohol use , comparable to patients without the disorder . PTSD patients received higher doses of opiate medication , attended more psychosocial treatment sessions for substance-use disorder , and had better treatment retention . Psychiatric symptoms for patients with PTSD were more severe at intake and showed little improvement throughout treatment . CONCLUSIONS Opioid substitution therapy is as effective at reducing substance use in PTSD patients as it is in patients without the disorder , but additional services are needed for treatment of psychological problems that are 
    Output:
    
Remarkably , no consistent indication of a negative effect of CO-PTSD on the reported SUD treatment outcome was found .