***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: Aims To determine whether the additional interventions to st and ard care are cost-effective in addressing cocaine and alcohol abuse at 4 months ( 4 M ) and 12 months ( 12 M ) from baseline . Method We conducted a cost-effectiveness analysis of a r and omized controlled trial with three arms : ( 1 ) NIDA 's St and ard intervention ( SI ) ; ( 2 ) SI plus a Well Woman Exam ( WWE ) ; and , ( 3 ) SI , WWE , plus four Educational Sessions ( 4ES ) . Results To obtain an additional cocaine abstainer , WWE compared to SI cost $ 7,223 at 4 M and $ 3,611 at 12 M. Per additional alcohol abstainer , WWE compared to SI cost $ 3,611 and $ 7,223 at 4 M and 12 M , respectively . At 12 M , 4ES was dominated ( more costly and less effective ) by WWE for abstinence outcomes . Conclusions To our knowledge , this is the first cost-effectiveness analysis simultaneously examining cocaine and alcohol abuse in women . Depending on primary outcomes sought and priorities of policy makers , peer-delivered interventions can be a cost-effective way to address the needs of this growing , underserved population . Trial Registration Clinical Trials.gov 82 Ss were studied in a comparative evaluation of a behavioral vs supportive treatment for illegal drug use .  Behavioral treatment included stimulus control , urge , control , contracting/family support and competing response procedures for an average of 19 sessions . 37 % of Ss in the behavioral condition were drug-free at 2 months , 54 % at 6 months , and 65 % at 12 months vs 20 + /- 6 % for the alternative treatment during all 12 months . The behavioral treatment was more effective across sex , age , educational level , marital status and type of drug ( hard-drugs , cocaine , and marijuana ) . Greater improvement for this condition was also noted on measures of employment/school attendance , family relationships , depression , institutionalization and alcohol use AIMS This study aim ed to determine the relative effectiveness of 12 months of interim methadone ( IM ; supervised methadone with emergency counseling only for the first 4 months of treatment ) , st and ard methadone treatment ( SM ; with routine counseling ) and restored methadone treatment ( RM : routine counseling with smaller case-loads ) . DESIGN A r and omized controlled trial was conducted comparing IM , SM and RM treatment . IM lasted for 4 months , after which participants were transferred to SM . SETTING The study was conducted in two methadone treatment programs in Baltimore , MD , USA . PARTICIPANTS The study included 230 adult methadone patients newly admitted through waiting-lists . MEASUREMENTS We administered the Addiction Severity Index and a supplemental question naire  at baseline , 4 and 12 months post- baseline . Measurements included retention in treatment , self-reported days of heroin and cocaine use , criminal behavior and arrests and urine tests for heroin and cocaine metabolites . FINDINGS At 12 months , on an intent-to-treat basis , there were no significant differences in retention in treatment among the IM , SM and RM groups ( 60.6 % , 54.8 % and 37.0 % , respectively ) . Positive urine tests for the three groups declined significantly from baseline ( Ps < 0.001 and 0.003 , for heroin and cocaine metabolites , respectively ) but there were no significant group x time interactions for these measures . At least one arrest was reported by 30.6 % of the sample during the year , but there were no significant between-group effects . CONCLUSIONS Limited availability of drug counseling services should not be a barrier to providing supervised methadone to adults dependent on heroin -- at least for the first 4 months of treatment Introduction While the impacts of illicit drug use on mortality have been well described , the impact of poly-substance that includes alcohol has received less attention . We examined the impact of binge alcohol use on mortality among a cohort of people who inject drugs ( PWID ) in a Canadian setting . Methods Using data derived from a prospect i ve cohort study of PWID in Vancouver , Canada recruited between May 1996 and November 2013 . We ascertained date s and causes of death through a confidential linkage with the provincial registry and examined the impact of binge alcohol use . The primary outcome of interest was all-cause mortality . We used Cox proportional hazard regression to determine factors associated with mortality , including socio-demographic characteristics , drug use patterns and other risk behaviours . Results During the study period , 2550 individuals were followed ( 844 of whom were HIV positive at baseline ) for a median of 75.4 months ( interquartile range 37.9–113.2 ) . Of these , 795 ( 31 % ) participants reported binge alcohol use at some time during the study period . In multivariable analyses , binge alcohol use remained independently associated with all-cause-mortality ( adjusted hazard ratio = 1.41 ; 95 % confidence interval : 1.06–1.88 ) after adjustment for other drug use patterns . Conclusions Binge alcohol use was associated with time to all-cause mortality  among PWID in this setting . Since alcohol use is often overlooked as a risk factor for mortality among this population , these findings highlight the continued need to incorporate addiction treatment and public health interventions and policies that address binge alcohol use to reduce alcohol related-harms Interventions for alcohol- and substance-dependent adults with comorbid depressive disorders are needed , but few have been empirically tested . In a r and omized clinical trial of two psychotherapy interventions for these disorders , we examined whether initial focus of treatment was related to retention , substance use , and depression outcomes . Both interventions , integrated cognitive-behavioral therapy ( ICBT ; n = 105 ) and twelve-step facilitation  ( n = 92 ) , were delivered in group formats with entry points every 4 weeks at the beginning of three content-distinct modules . Entry module ( i.e. , initial treatment focus ) was not related to percentage days abstinent , proportion of the sample abstinent , or depression symptoms for either intervention . This was true at both 12 and 24 weeks postbaseline . Furthermore , attendance was similar for both treatments , regardless of initial treatment focus , with a single exception in the ICBT condition . Our findings support the use of modular formats with multiple or rotating entry points for psychotherapy group interventions Active injection drug users ( IDUs ) who are also hazardous alcohol users are at particularly high risk for HIV transmission due to sharing of injection equipment . We recruited AUDIT-positive injectors from the Providence , RI needle exchange program for a r and omized clinical trial testing the effect of a brief motivational intervention ( MI ) on frequency of injection-related HIV risk behavior ( IRRB ) . HIV drug risk behavior was measured as the number of days on which subjects reported sharing works using the 30-day Timeline Followback Method . Overall , 109 subjects reported a mean reduction of IRRB days of 9.1 days from baseline to 6-month follow-up ( p < .001 ) . When compared to controls , there was a trend in reduction of IRRB days to zero at follow-up for MI subject ( OR = 2.1 ; 95 % CI = 0.9 - 4.5 ) , and strongly significant reductions in IRRB days across a range of alternative improvement thresholds . Results from this study demonstrate that MI reduces drug-related HIV risk behaviors among active IDUs . As a brief intervention , MI may be a useful adjunct to existing services intended to reduce harm 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 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 OBJECTIVES We compared the effects of 2 interventions on alcohol use , use of a new syringe at last injection , and condom use at last sexual encounter in a community sample of injection drug users . METHODS Between 2003 and 2006 , 851 out-of-treatment injection drug users were recruited in Raleigh , NC , and Durham , NC , through street outreach and were r and omly assigned to either a 6-session educational intervention or a 6-session motivational intervention . Intervention effects were examined at 6 and 12 months after enrollment . RESULTS In multiple logistic regression analyses adjusted for baseline alcohol use and HCV status , participants assigned to the motivational intervention were significantly less likely than were participants in the educational intervention to be drinking at the 6-month follow-up ( odds ratio = 0.67 ; 95 % confidence interval = 0.46 , 0.97 ) . There were no significant between-group differences in use of a new syringe at last injection or condom use at last sexual encounter at either follow-up . CONCLUSIONS Reducing alcohol use among persons with HCV may slow disease progression and provide important health benefits . Additional strategies are needed for slowing HCV disease progression until more effective HCV treatments are available Background Alcohol use is an important issue among problem drug users . Although screening and brief intervention ( SBI ) are effective in reducing problem alcohol use in primary care , no research has examined this issue among problem drug users . Objective The objective of this study is to determine if a complex intervention including SBI for problem alcohol use among problem drug users is feasible and acceptable in practice . This study also aims to evaluate the effectiveness of the intervention in reducing the proportion of patients with problem alcohol use . Methods Psychosocial intervention for alcohol use among problem drug users ( PINTA ) is a pilot feasibility study of a complex intervention comprising SBI for problem alcohol use among problem drug users with cluster r and omization at the level of general practice , integrated qualitative process evaluation , and involving general practice s in two socioeconomically deprived regions . Practice s ( N=16 ) will be eligible to participate if they are registered to prescribe methadone and /or at least 10 patients of the practice are currently receiving addiction treatment . Patient must meet the following inclusion criteria to participate in this study : 18 years of age or older , receiving addiction treatment/care ( eg , methadone ) , or known to be a problem drug user . This study is based on a complex intervention supporting SBI for problem alcohol use among problem drug users ( experimental group ) compared to an “ assessment -only ” control group . Control practice s will be provided with a delayed intervention after follow-up . Primary outcomes of the study are feasibility and acceptability of the intervention to patients and practitioners . Secondary outcome includes the effectiveness of the intervention on care process ( documented rates of SBI ) and outcome ( proportion of patients with problem alcohol use at the follow-up ) . A stratified r and om sampling method will be used to select general practice s based on the level of training for providing addiction-related care and geographical area . In this study , general practitioners and practice staff , research ers , and trainers will not be blinded to treatment , but patients and remote r and omizers will be unaware of the treatment . Results This study is ongoing and a protocol system is being developed for the study . This study may inform future research among the high-risk population of problem drug users by providing initial indications as to whether psychosocial interventions for problem alcohol use are feasible , acceptable , and also effective among problem drug users attending primary care . Conclusions This is the first study to examine the feasibility and acceptability of complex intervention in primary care to enhance alcohol SBI among problem drug users . Results of this study will inform future research among this high-risk population and guide policy and service development locally and internationally Aim To develop and evaluate the comparative effectiveness of behavioural interventions of enhanced prevention counselling ( EPC ) and simple educational counselling ( SEC ) in reducing hepatitis C viral ( HCV ) infection in sero-negative injecting drug users ( IDU ) 
    Output:
    
There is low- quality evidence to suggest that there is no difference in effectiveness between different types of interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users and that brief interventions are not superior to assessment -only or to treatment as usual .