***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: BACKGROUND Brief interventions for  problem drinking  in medical setting s are effective but rarely conducted , mainly due to insufficient time . A stepped care approach ( starting with a very brief intervention and intensifying efforts in case of no success ) could save re sources and enlarge effectiveness ; however , research is lacking . The present study compares a full care brief intervention for patients with at-risk drinking , alcohol abuse or dependence with a stepped care approach in a r and omized controlled trial . METHODS Participants were proactively recruited from general practice s in two northern German cities . In total , 10,803 screenings were conducted ( refusal rate : 5 % ) . Alcohol use disorders according to DSM-IV were assessed with the Munich-Composite International Diagnostic Interview ( M-CIDI ) . Eligible participants were r and omly assigned to one of three conditions : ( 1 ) stepped care ( SC ) : a computerized intervention plus up to three 40-min telephone-based interventions depending on the success of the previous intervention ; ( 2 ) full-care ( FC ) : a computerized intervention plus a fixed number of four 30-min telephone-based interventions that equals the maximum of the stepped care intervention ; ( 3 ) an untreated control group ( CG ) .  Counseling effort in the intervention conditions and quantity/frequency of drinking were assessed at 12-month follow-up . RESULTS SC participants received roughly half of the amount of intervention in minutes compared to FC participants . Both groups did not differ in drinking outcomes . Compared to CG , intervention showed small to medium effect size for at-risk drinkers . CONCLUSIONS Study results reveal that a stepped care approach can be expected to increase cost-effectiveness of brief interventions for individuals with at-risk drinking AIM To establish the efficacy of a brief motivational intervention compared to feedback only when delivered in an emergency department for reducing alcohol use and problems among young adults . DESIGN Two-group r and omized controlled trial with follow-up assessment s at 6 and 12 months . SETTING Level I Trauma Center . PARTICIPANTS A total of 198 18 - 24-year-old patients who were either alcohol positive upon hospital admission or met screening criteria for alcohol problems . INTERVENTION Participants were assigned r and omly to receive a one-session motivational intervention ( MI ) that included personalized feedback , or the personalized feedback report only ( FO ) . All participants received additional telephone contact 1 month and 3 months after baseline . MEASUREMENTS Demographic information , alcohol use , alcohol problems and treatment seeking . FINDINGS Six months after the intervention MI participants drank on fewer days , had fewer heavy drinking days and drank fewer drinks per week in the past month than did FO patients . These effects were maintained at 12 months . Clinical significance evaluation indicated that twice as many MI participants as FO participants reliably reduced their volume of alcohol consumption from baseline to 12 months . Reductions in alcohol-related injuries and moving violations , and increases in alcohol treatment-seeking were observed across both conditions at both follow-ups with no differences between conditions . CONCLUSIONS This study provides new data supporting the potential of the motivational intervention tested to reduce alcohol consumption among high-risk youth BACKGROUND Risky driving and hazardous drinking are associated with significant human and economic costs . Brief interventions for more than one risky behavior have the potential to reduce health-compromising behaviors in population s with multiple risk-taking behaviors such as young adults . Emergency department ( ED ) visits provide a window of opportunity for interventions meant to reduce both risky driving and hazardous drinking . METHODS We determined the efficacy of a Screening , Brief Intervention , and Referral to Treatment ( SBIRT ) protocol addressing risky driving and hazardous drinking . We used a r and omized controlled trial design with follow-ups through 12 months . ED patients aged 18 to 44 who screened positive for both behaviors ( n = 476 ) were r and omized to brief intervention ( BIG ) , contact control ( CCG ) , or no-contact control ( NCG ) groups . The BIG ( n = 150 ) received a 20-minute assessment and two 20-minute interventions . The CCG ( n = 162 ) received a 20-minute assessment at baseline and no intervention . The NCG ( n = 164 ) were asked for contact information at baseline and had no assessment or intervention . Outcomes at 3 , 6 , 9 , and 12 months were self-reported driving behaviors and alcohol consumption . RESULTS Outcomes were significantly lower in BIG compared with CCG through 6 or 9 months , but not at 12 months : Safety belt use at 3 months ( adjusted odds ratio [ AOR ] , 0.22 ; 95 % confidence interval [ CI ] , 0.08 to 0.65 ) ; 6 months ( AOR , 0.13 ; 95 % CI , 0.04 to 0.42 ) ; and 9 months ( AOR , 0.18 ; 95 % CI , 0.06 to 0.56 ) ; binge drinking at 3 months ( adjusted rate ratio [ ARR ] 0.84 ; 95 % CI , 0.74 to 0.97 ) and 6 months ( ARR , 0.81 ; 95 % CI , 0.67 to 0.97 ) ; and ≥5 st and ard drinks/d at 3 months ( AOR , 0.43 ; 95 % CI , 0.20 to 0.91 ) and 6 months ( AOR , 0.41 ; 95 % CI , 0.17 to 0.98 ) . No substantial differences were observed between BIG and NCG at 12 months . CONCLUSIONS Our findings indicate that SBIRT reduced risky driving and hazardous drinking  in young adults , but its effects did not persist after 9 months . Future research should explore methods for extending the intervention effect OBJECTIVE This study was design ed to conduct a r and omized controlled trial of motivational enhancement therapy ( MET ) with two control conditions : nondirective reflective listening ( NDRL ) and no further counseling ( NFC ) ; and to conduct this study in a sample of patients with a primary diagnosis of mild to moderate alcohol dependence , in a " real-life " clinical setting . METHOD Patients with mild to moderate alcohol dependence were recruited , assessed and treated at the Community Alcohol and Drug Service of Christchurch , New Zeal and . All patients received a feedback/education session before r and omization to either four sessions of MET , four sessions of NDRL , or NFC . Outcome data on 122 subjects ( 57.4 % men ) were obtained 6 months following the end of treatment , by an interviewer who was blind to the treatment condition . The primary drinking outcome was unequivocal heavy drinking , defined as drinking 10 or more st and ard drinks six or more times in the follow-up period . Global assessment scale ( GAS ) measured general personal/social functioning . RESULTS Of patients treated with MET , 42.9 % showed unequivocal heavy drinking compared with 62.5 % of the NDRL and 65.0 % of the NFC groups ( p = .04 ) . No significant differences were found for GAS score according to treatment condition . CONCLUSIONS In patients with mild to moderate alcohol dependence , MET is more effective for reducing unequivocal heavy drinking than either a feedback/education session alone or four sessions of NDRL . MET can be considered an effective " value added " counseling intervention in a real-life clinical setting . In patients with mild to moderate alcohol dependence , nondirective reflective listening provides no additional advantage over a feedback/education session alone BACKGROUND Patient involvement in the decision-making process is a key element for good clinical practice . Few data are available on patient involvement in psychiatry . AIMS To assess in a psychiatric out-patient context how psychiatrists involve patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement . METHOD Eighty transcripts from audiotaped first out-patient consultations , conducted by 16 psychiatrists , were rated with the OPTION ( observing patient involvement ) scale . Interrater reliability indices were obtained for 30 r and omly selected interviews . Associations between OPTION scores and some clinical and socio-demographic variables were tested using t-test , ANOVA and Pearson 's correlation coefficient where appropriate . The distribution of scores for each psychiatrist was assessed by intracluster correlation coefficients . RESULTS Interrater reliability and internal consistency of the OPTION scale in the psychiatric setting were satisfactory . The total score and the ratings for the single OPTION items showed a skewed distribution , with a prevalence of scores in the low range of abilities , corresponding to minimal attempts to involve patients or a minimal skill level . CONCLUSIONS The OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting . Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care . They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills . Further research is needed to establish which patient variables and clinical setting s in psychiatry are more amenable to shared decisions , and how participation of psychiatric patients in treatment decisions will affect the outcome This study evaluated the efficacy of as-needed use of the opioid system modulator nalmefene in reducing alcohol consumption in patients with alcohol dependence . Seven hundred and eighteen patients ( placebo=360 ; nalmefene=358 ) , ≥ 18 years of age , with a diagnosis of alcohol dependence , ≥ 6 heavy drinking days and an average alcohol consumption ≥ WHO medium drinking risk level in the 4 weeks preceding screening , were r and omised ( 1:1 ) to 24 weeks of as-needed  placebo or nalmefene 18 mg/day . The co- primary efficacy analyses showed a significantly superior effect of nalmefene compared to placebo in the change from baseline to month 6 in heavy drinking days ( group difference : -1.7 days/month [ 95 % CI -3.1 ; -0.4 ] ; p=0.012 ) and a better but not significant effect in reducing total alcohol consumption ( group difference : -5.0 g/day last month [ 95 % CI -10.6 ; 0.7 ] ; p=0.088 ) . A subgroup analysis showed that patients who did not reduce their drinking prior to r and omisation benefitted more from nalmefene . Improvements in Clinical Global Impression and reductions in liver enzymes were greater in the nalmefene group than in the placebo group . Adverse events were more common with nalmefene ; the incidence of adverse events leading to dropout was similar in both groups . This study provides evidence for the efficacy of nalmefene , which constitutes a new pharmacological treatment paradigm in terms of treatment goal ( reduced drinking ) and dosing regimen ( as-needed ) , in alcohol dependent patients unable to reduce alcohol consumption on their own The relationship between individuals ' choice of abstinence or moderate drinking during  outpatient behavioral management treatment  and outcome over 12 months ' posttreatment was examined . At the initial assessment , 46 % of 106 chronic alcoholic subjects chose abstinence , 44 % chose moderate drinking , and 9 % were unsure . Over the course of treatment , subjects were more likely to move from moderation to abstinence goals , and after the first 4 weeks of treatment , two-thirds chose abstinence . These subjects were older , had more severe alcohol problems ( i.e. , higher MAST scores ) , and were more likely to maintain their weekly alcohol consumption goals during the 16-week treatment period . Moreover , these subjects reported less alcohol use in the 12 month follow-up period , and a greater proportion were judged as having successful outcomes . The implication s of these findings are discussed BACKGROUND Heavy drinking is one of the leading causes of morbidity and mortality in young men .  Brief motivational intervention ( BMI ) has shown promising results for young people , but has never been tested in young men in the community who volunteered to receive an intervention . METHODS We evaluated the effectiveness of  BMI  in reducing alcohol use  among heavy episodic users and in maintaining low-risk drinking among nonheavy episodic users . Participants were French-speaking young men attending the m and atory Swiss army conscription process . They were offered the opportunity to receive a 20-minute BMI , and those interested were r and omized into an intervention group ( BMI immediately ) or into a control group ( BMI after the 6-month follow-up assessment , in a waiting list design ) . Analyses were conducted separately for heavy and nonheavy episodic users ( separated using baseline heavy episodic use frequency ) as the hypotheses tested were different between both groups ( primary vs. secondary prevention intervention ) . RESULTS From a pool of 6,085 young men invited to receive BMI , 727 ( 11.9 % ) showed up and 572 were included in the study ( after exclusions related to organizational aspects of the conscription process ) . Among nonheavy episodic users , there was a protective effect of BMI on weekly alcohol use ( p < 0.05 ) . Among heavy episodic users , there were no significant effects of BMI . CONCLUSIONS About 12 % of young men were interested in addressing their drinking within the BMI framework , suggesting that there is some need for easily accessible alcohol intervention . The present intervention did have a preventive effect among low-risk young drinkers in helping them maintain their patterns of alcohol use . An explanation for the lack of effectiveness among heavy episodic users might be that those individuals interested in BMI had patterns of more severe alcohol use , thereby making change more difficult Background Russia has particularly low life expectancy for an industrialised country , with mortality at working ages having fluctuated dramatically over 
    Output:
    
Results from single sessions of motivational interviewing showed no clear benefit on alcohol consumption outcomes , with few studies indicating benefit of PCC versus control .
Although the results for studies of multiple sessions of counseling were also mixed , many did show a significant benefit of the PCC intervention .
By contrast , studies consistently demonstrated a benefit of pharmacologically supported PCC interventions , with most of the differences reaching statistical significance .
IMPLICATION S PCC-based interventions may be beneficial for reducing alcohol consumption in people with alcohol use disorders