***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: Disturbed sleep is a common problem , particularly among elderly people , and is usually treated with hypnotics . The side effects of longterm administration of hypnotic drugs are well known , but despite this there remains a substantial population of chronic users . These people can be helped to reduce their dependence on hypnotics through psychological techniques . A group of longterm users treated in this manner were shown to reduce their intake of hypnotics  significantly more than a group of users who did not receive any psychological treatment . Furthermore , the treated patients did not experience any deterioration in their sleep patterns , and their subjective refreshment from sleep improved significantly . For the patient with sleep problems , psychological techniques are preferable to the longterm use of hypnotics both as a weaning-off agent and as an alternative to drugs We described characteristics of subjects with benzodiazepine dependence that was typically complicated by harmful and hazardous alcohol use or high benzodiazepine doses , and assessed predictors of successful discontinuation of benzodiazepines for this group . Seventy-six patients who participated in a r and omized clinical trial of two different gradual withdrawal treatment approaches were assessed . The trial was conducted between February 1995 and July 1999 . The mean age ±SD of subjects was 40.0±9.6 years , 55 % were male , 38 % were married or cohabiting , and 70 % had received more than nine years of education . The median benzodiazepine dose was 35 mg /day ( range 2.5–180 ) in diazepam equivalents . The median duration of benzodiazepine use was 84 ( range 8–360 ) months . Subjects with lower benzodiazepine doses and no previous withdrawal attempts were more successful at benzodiazepine discontinuation . Cluster B personality/borderline personality disorder was associated with an inability to stop benzodiazepine use and with “ dropping out ” of treatment . Alcohol use – related disorders or other psychiatric diagnoses were not associated with outcome . Further studies on predictors of successful  benzodiazepine discontinuation in different population s are required . Patients manifesting cluster B personality/borderline personality disorder and benzodiazepine dependence may need concomitant treatment for their personality disorders to benefit from benzodiazepine discontinuation treatment Background The prevalence of substance use in people acutely admitted to in-patient psychiatric wards is high and the patients ` duration of stay is limited . Motivational interviewing is a method with evidence based effect in short interventions . The aims of the present study were to compare the effects of 2 sessions of motivational interviewing and treatment as usual ( intervention group ) with treatment as usual only ( control group ) on adult patients with comorbid substance use admitted to a psychiatric in-patient emergency unit . Methods This was an open r and omised controlled trial including 135 patients where substance use influenced the admittance . After admission and assessment s , the patients were allocated to the intervention group ( n = 67 ) or the control group ( n = 68 ) . The primary outcome was self-reported days per month of substance use during the last 3 months at 3 , 6 , 12 and 24 months after inclusion . Data was analysed with a multilevel linear repeated measures regression model . Results Both groups reduced substance use during the first 12 months with no substantial difference between the 2 groups . At 2 year follow-up , the control group had increased their substance use with 2.4 days ( 95 % confidence interval ( CI ) –1.5 to 6.3 ) , whereas the intervention group had reduced their monthly substance use with 4.9 days ( 95 % CI 1.2 to 8.6 ) compared to baseline . The 2 year net difference was 7.3 days of substance use per month ( 95 % CI 1.9 to 12.6 , p < 0.01 ) in favour of the intervention group . Conclusions The present study suggests that 2 sessions of motivational interviewing to patients with comorbid substance use admitted to a psychiatric emergency unit reduce substance use frequency substantially at 2 year follow-up . Trial registration Clinical Trials.gov Identifier : Eighty-six participants wishing to stop benzodiazepine and who met DSM-IV ( Diagnostic and Statistical Manual of Mental Disorders , 4th ed . American Psychological Association , 1994 ) criteria for anxiety disorder or insomnia were assessed pre- and post-taper on clinical , pharmacological and psychosocial measures . An initial cohort of 41 participants received treatment as usual ( taper only ) plus physician counselling in the same clinic setting . A second cohort of 45 participants were r and omly allocated to group cognitive-behavioural therapy ( CBT ) plus taper , or group support ( GS ) plus taper . At 3 months follow-up , the outcomes in both the CBT and the GS subgroups were equivalent . Intention to treat analysis revealed a slight advantage to the CBT over the GS group and the CBT group showed higher self-efficacy post-taper . Over all 86 participants , a high-baseline level of psychological distress , anxiety and dosage predicted a poor outcome , but increase in self-efficacy contributed to a successful outcome particularly in those with initially poor baseline predictors . Although there was a decrease in positive affect during preliminary stages of tapered discontinuation compared to baseline , there was no significant overall increase in negative affect Objective To evaluate the association between use of benzodiazepines and incident dementia . Design Prospect i ve , population based study . Setting PAQUID study , France . Participants 1063 men and women ( mean age 78.2 years ) who were free of dementia and did not start taking benzodiazepines until at least the third year of follow-up . Main outcome measures Incident dementia , confirmed by a neurologist . Results During a 15 year follow-up , 253 incident cases of dementia were confirmed . New use of benzodiazepines was associated with an increased risk of dementia ( multivariable adjusted hazard ratio 1.60 , 95 % confidence interval 1.08 to 2.38 ) . Sensitivity analysis considering the existence of depressive symptoms showed a similar association ( hazard ratio 1.62 , 1.08 to 2.43 ) . A secondary analysis pooled cohorts of participants who started benzodiazepines during follow-up and evaluated the association with incident dementia . The pooled hazard ratio across the five cohorts of new benzodiazepine users was 1.46 ( 1.10 to 1.94 ) . Results of a complementary nested case-control study showed that ever use of benzodiazepines was associated with an approximately 50 % increase in the risk of dementia ( adjusted odds ratio 1.55 , 1.24 to 1.95 ) compared with never users . The results were similar in past users ( odds ratio 1.56 , 1.23 to 1.98 ) and recent users ( 1.48 , 0.83 to 2.63 ) but reached significance only for past users . Conclusions In this prospect i ve population based study , new use of benzodiazepines was associated with increased risk of dementia . The result was robust in pooled analyses across cohorts of new users of benzodiazepines throughout the study and in a complementary case-control study . Considering the extent to which benzodiazepines are prescribed and the number of potential adverse effects of this drug class in the general population , indiscriminate widespread use should be caution ed against OBJECTIVE This study tested cognitive behavior therapy ( CBT ) in hypnotic-dependent , late middle-age and older adults with insomnia . METHOD Seventy volunteers age 50 and older were r and omized to CBT plus drug withdrawal , placebo biofeedback ( PL ) plus drug withdrawal , or drug withdrawal ( MED ) only . The CBT and PL groups received eight , 45 min weekly treatment sessions . The drug withdrawal protocol comprised slow tapering monitored with about six biweekly , 30 min sessions . Assessment including  polysomnography ( PSG ) , sleep diaries , hypnotic consumption , daytime functioning question naires , and drug screens collected at baseline , posttreatment , and 1-year follow-up . RESULTS Only the CBT group showed significant sleep diary improvement , sleep onset latency significantly decreased at posttreatment . For all sleep diary measures for all groups , including MED , sleep trended to improvement from baseline to follow-up . Most PSG sleep variables did not significantly change . There were no significant between group differences in medication reduction . Compared to baseline , the three groups decreased hypnotic use at posttreatment , down 84 % , and follow-up , down 66 % . There was no evidence of withdrawal side-effects . Daytime functioning , including anxiety and depression , improved by posttreatment . Rigorous method ological features , including documentation of strong treatment implementation and the presence of a credible placebo , elevated the confidence due these findings . CONCLUSIONS Gradual drug withdrawal was associated with substantial hypnotic reduction at posttreatment and follow-up , and withdrawal side-effects were absent . When supplemented with CBT , participants accrued incremental self-reported , but not PSG , sleep benefits AIMS Chronic benzodiazepine use is highly prevalent and is associated with a variety of negative health consequences . The present study examined the long-term effectiveness of a  tailored patient education intervention on benzodiazepine use . DESIGN A r and omized controlled trial was conducted comprising three arms , comparing ( i ) a single tailored intervention ; ( ii ) a multiple tailored intervention and ( iii ) a general practitioner letter . The post-test took place after 12 months . PARTICIPANTS Five hundred and eight patients using benzodiazepines were recruited by their general practitioners and assigned r and omly to one of the three groups . INTERVENTION Two tailored interventions , the single tailored intervention ( patients received one tailored letter ) and the multiple tailored intervention ( patients received three sequential tailored letters at intervals of 1 month ) , were compared to a short general practitioner letter that modelled usual care . The tailored interventions not only provided different and more information than the general practitioner letter ; they were also personalized and adapted to individual baseline characteristics . The information in both tailored interventions was the same , but in the multiple tailored intervention the information was provided to the participants spread over three occasions . In the multiple tailored intervention , the second and the third tailored letters were based on short and st and ardized telephone interviews . MEASUREMENTS Benzodiazepine cessation at post-test was the outcome measure . FINDINGS The results showed that participants receiving the tailored interventions were twice as likely to have quit benzodiazepine use compared to the general practitioner letter . Particularly among participants with the intention to discontinue usage at baseline , both tailored interventions led to high percentages of those who actually discontinued usage ( single tailored intervention 51.7 % ; multiple tailored intervention 35.6 % ; general practitioner letter 14.5 % ) . CONCLUSIONS It was concluded that tailored patient education can be an effective tool for reducing benzodiazepine use , and can be implemented easily This study examined contingent methadone take-home privileges for effectiveness in reducing on-going supplemental drug use of methadone maintenance patients . Fifty-three new intakes were r and omly assigned to begin receiving take-home privileges after 2 consecutive weeks of drug-free urines or to a noncontingent procedure in which take-homes were delivered independently of urine test results . The contingent procedure produced more individuals with at least 4 consecutive weeks of abstinence ( 32 % vs. 8 % ) ; 28 % of noncontingent subjects also achieved abstinence after shifting to the contingent procedure . Lower baseline rate of drug-free urines was strongly associated with successful outcome , whereas the type of drug abused ( cocaine vs. benzodiazepines ) did not influence outcomes . Findings support a recommendation for using contingent take-home incentives to motivate abstinence during methadone maintenance treatment This study evaluated the specific effectiveness of cognitive-behavior therapy ( CBT ) combined with medication tapering for benzodiazepine discontinuation among generalized anxiety disorder ( GAD ) patients by using a nonspecific therapy control group . Sixty-one patients who had used benzodiazepines for more than 12 months were r and omly assigned to the experimental conditions . Nearly 75 % of patients in the CBT condition completely ceased benzodiazepine intake , as compared with 37 % in the control condition . Results of the 3- , 6- , and 12-month follow-ups confirmed the maintenance of complete cessation . Discontinuation rates remained twice as high in the CBT condition . The number of patients who no longer met GAD criteria was also greater in the CBT condition . The addition of specific CBT components thus seemed to facilitate benzodiazepine tapering among patients with GAD BACKGROUND Benzodiazepine withdrawal programmes have never been experimentally compared with a nonintervention control condition . AIMS To evaluate the efficacy and feasibility of tapering off long-term benzodiazepine use in general practice , and to evaluate the value of additional group cognitive-behavioural therapy ( CBT ) . METHOD A 3-month r and omised , 3-month controlled trial was conducted in which 180 people attempting to discontinue long-term benzodiazepine use were assigned to tapering off plus group CBT , tapering off alone or usual care . RESULTS Tapering off led to a significantly higher proportion of successful discontinuations than usual care ( 62 % nu . 21 % ) . Adding group CBT did not increase the success rate ( 58 % v. 62 % ) . Neither successful discontinuation nor intervention type affected psychological functioning . Both tapering strategies showed good feasibilityin general practice . CONCLUSIONS Tapering off is a feasible and effective way of discontinuing long-term benzodiazepine use in general practice . The addition of group CBT is of limited value Despite recent emphasis on integr 
    Output:
    
AUTHORS ' CONCLUSIONS CBT plus taper is effective in the short term ( three month time period ) in reducing BZD use .
However , this is not sustained at six months and subsequently .
Currently there is insufficient evidence to support the use of MI to reduce BZD use .
There is emerging evidence to suggest that a tailored GP letter versus a generic GP letter , a st and ardised interview versus TAU , and relaxation versus TAU could be effective for BZD reduction .
There is currently insufficient evidence for other approaches to reduce BZD use