***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: CONTEXT The prevalence of medical disorders is high among substance abuse patients , yet medical services are seldom provided in coordination with substance abuse treatment . OBJECTIVE To examine differences in treatment outcomes and costs between integrated and independent models of medical and substance abuse care as well as the effect of integrated care in a subgroup of patients with substance abuse-related medical conditions ( SAMCs ) . DESIGN R and omized controlled trial conducted between April 1997 and December 1998 . SETTING AND PATIENTS Adult men and women ( n = 592 ) who were admitted to a large health maintenance organization chemical dependency program in Sacramento , Calif. INTERVENTIONS Patients were r and omly assigned to receive treatment through an integrated model , in which primary health care was included within the addiction treatment program ( n = 285 ) , or an independent treatment-as-usual model , in which primary care and substance abuse treatment were provided separately ( n = 307 ) . Both programs were group based and lasted 8 weeks , with 10 months of aftercare available . MAIN OUTCOME MEASURES Abstinence outcomes , treatment utilization , and costs 6 months after r and omization . RESULTS Both groups showed improvement on all drug and alcohol measures . Overall , there were no differences in total abstinence rates between the integrated care and independent care groups ( 68 % vs 63 % , P = .18 ) . For patients without SAMCs , there were also no differences in abstinence rates ( integrated care , 66 % vs independent care , 73 % ; P = .23 ) and there was a slight but nonsignificant trend of higher costs for the integrated care group ( $ 367.96 vs $ 324.09 , P = .19 ) . However , patients with SAMCs ( n = 341 ) were more likely to be abstinent in the integrated care group than the independent care group ( 69 % vs 55 % , P = .006 ; odds ratio [ OR ] , 1.90 ; 95 % confidence interval [ CI ] , 1.22 - 2.97 ) . This was true for both those with medical ( OR , 3.38 ; 95 % CI , 1.68 - 6.80 ) and psychiatric ( OR , 2.10 ; 95 % CI , 1.04 - 4.25 ) SAMCs . Patients with SAMCs had a slight but nonsignificant trend of higher costs in the integrated care group ( $ 470.81 vs $ 427.95 , P = .14 ) . The incremental cost-effectiveness ratio per additional abstinent patient with an SAMC in the integrated care group was $ 1581 . CONCLUSIONS Individuals with SAMCs benefit from integrated medical and substance abuse treatment , and such an approach can be cost-effective . These findings are relevant given the high prevalence and cost of medical conditions among substance abuse patients , new developments in medications for addiction , and recent legislation on parity of substance abuse with other medical benefits OBJECTIVE This article examines  client drinking and related psychosocial functioning during the course of alcoholism treatment .  It focuses on ( 1 ) the main effects of the three Project MATCH treatments , ( 2 ) the prognostic value of client attributes employed in the matching hypotheses , and ( 3 ) the attribute by treatment interaction effects . METHOD Clients recruited from outpatient setting s ( n = 952 ) or from aftercare setting s ( n = 774 ) were r and omized to one of the following treatments : Motivational Enhancement Therapy ( MET ) , Cognitive Behavioral Therapy ( CBT ) and Twelve-Step Facilitation ( TSF ) .  Alcohol consumption and psychosocial functioning during treatment were assessed at the end of the 12-week treatment phase . RESULTS During the treatment phase , small but statistically significant differences among treatments were found only in the outpatient arm on measures of alcohol consumption and alcohol-related negative consequences . Forty-one percent ( 41 % ) of CBT and TSF clients were abstinent or drank moderately without alcohol-related consequences , compared with 28 % of MET clients . Tests of 10 a priori primary client-treatment matching hypotheses failed to find any interaction effects that had an impact on drinking throughout the treatment phase . CONCLUSIONS In the outpatient setting there appears to be a temporary advantage to assigning individuals to CBT or TSF rather than MET . When there is a need to quickly reduce heavy drinking and alcohol-related consequences , it appears that CBT or TSF should be the treatment of choice Objective : Mobile technology has the potential to radically improve addiction treatment and continuing care by offering emotional and instrumental support anywhere and just in time . This is particularly important in addiction because timing is critical to preventing relapse . Although most experts consider alcoholism to be a chronic disease , providers do not typically offer ongoing support for relapse prevention after patients complete treatment , even though a central characteristic of alcoholism and other addictive behaviors is their chronically relapsing nature . A-CHESS is a smartphone-based system for preventing relapse to heavy drinking among people leaving active alcohol dependence treatment .  A-CHESS is design ed to improve competence , social relatedness , and motivation , the three tenets of self-determination theory . This paper reports on the relative impact and use of A-CHESS 4 months after patients entered the study and discusses implication s of the results on treating addiction and chronic diseases generally . Methods : A total of 349 individuals with alcohol dependence leaving residential treatment were r and omly assigned to either receive A-CHESS + Treatment as usual or treatment as usual ( st and ard aftercare ) . Patients came from two treatment agencies , one in the Midwest and one in the Northeast . Patients assigned to A-CHESS received a smartphone for 8 months and were followed for 12 . The authors analyzed use patterns during the first 4 months of use by those receiving A-CHESS . Results : Participants used A-CHESS  heavily and sustained their use over time . Ninety-four percent of A-CHESS participants used the application during the first week after residential treatment . At week 16 , almost 80 % continued to  access A-CHESS .  Participants with alcohol and drug dependence showed higher levels of system use than those with alcohol dependence only . Participants with a mental health diagnosis had slightly lower levels of use at the end of the intervention period ( week 16 ) , although more than 70 % still accessed the system . Conclusions : These findings illustrate that patients with alcohol dependence , alcohol and drug dependence , and mental health issues will use smartphone applications such as A-CHESS for ongoing support , re sources , and information , thus extending patient care if given the opportunity . Further analysis is needed to determine whether sustained A-CHESS use improves outcomes . This clinical trial is registered at www . clinical trials.gov as trial # NCT01003119 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Developed and evaluated a home-based contracting program to determine its effect on the compliance rates of discharged alcohol patients to a disulfiram ( antabuse ) regimen .  The three comparison groups included ( a ) no contract/no recording ; ( b ) contract/recording ; and ( c ) contract/recording plus instructions for positive reinforcement .  Twenty-five patients who had been treated in a behaviorally oriented inpatient alcohol dependence treatment program and who lived with a significant other ( i.e. , spouse , sibling , parent ) participated in the study . At the end of the 3-month period for which the disulfiram was prescribed , those Ss who were involved in contracting and recording reached criterion more frequently than those who were in the minimal treatment group . Furthermore , 84 % of this S sample were abstinent at the 3-month follow-up according to collateral reports . The discussion centers on the use of home-based contracting as an inexpensive alternative to other , more costly disulfiram programs . Additional methods for obtaining measures of reliability on self-report of disulfiram usage also are discussed Alcoholics from two hospital-based treatment centers participated in an experimental test of the effects of extended aftercare on inpatient recovery rates . At discharge from inpatient treatment , subjects were r and omly assigned either to an  experimental group scheduled to be called by a center counselor every 2 weeks for 1 year or to a control group that experienced only the usual treatment . Follow-up interviews conducted approximately 12 months after hospital discharge found that the experimental group had no higher recovery rates than the control group . There was weak evidence that the calls reduced the burden that alcoholics place on community control and service agencies . There was no evidence that either the phone calls were more effective for some patients than for others or that some kinds of phone calls were more effective than others . Although most subjects said they liked the calls , wanted them to continue and perceived them as " good treatment , " only one subject gave the calls credit for helping him maintain sobriety This study evaluated whether alcoholics who received couples relapse prevention ( RP ) sessions in the year after short-term behavioral marital therapy ( BMT )  did better than those who did not receive additional RP .  Couples ( n = 59 ) with an alcoholic husb and , after participating in weekly BMT couples sessions for 5 months , were assigned r and omly to receive or not receive 15 additional conjoint couples relapse prevention ( RP ) sessions over the next 12 months . Outcome measures were collected before and after BMT and at quarterly intervals for the year after BMT . Significant improvements in the  alcoholics ' drinking and the couple 's marital adjustment occurred from before to after BMT replicating results of our own and other 's earlier studies of BMT with alcoholics , and outcomes remained significantly improved through 12-months follow-up independent of the amount of aftercare received . Given these favorable outcomes overall , the present study provided a stringent test of the hypothesized utility of RP . As predicted , alcoholics who received RP after BMT had more days abstinent and fewer days drinking , maintained their improved marriages better and used behaviors targeted by BMT more than those who received BMT alone . The prediction that greater continued use of behaviors targeted by BMT would be associated with better outcomes irrespective of the amount of aftercare received also was supported . The final prediction that couples with more severe alcohol and marital problems at study entry would show the greatest additional benefit from RP was not supported . The relatively clear-cut findings favoring RP may be due to the fact that RP in this study was an intensive , multifaceted booster maintenance intervention delivered in a couples format over a lengthy period of time . Moreover , the present results occurred during the time that couples were still getting RP . Limitations to the generalizability and interpretation of the results are discussed OBJECTIVE To examine the impact of three common comorbid disorders on a variety of outcomes 3 years after  inpatient alcoholism treatment .  METHOD Using a prospect i ve cohort design , we examined the frequency and intensity of drinking , the severity of alcohol-related symptoms , global alcohol-related outcome and severity of psychiatric symptoms in a group of 225 ( 74 % male ) alcoholics . At the index admission , patients were categorized as to the lifetime presence of major depression , antisocial personality disorder ( ASP ) and drug abuse/dependence .  Multiple linear regression was used hierarchically to step in blocks of predictors in a logical sequence : ( 1 ) gender and age ; ( 2 ) number of comorbid psychiatric diagnoses and the presence or absence of the three individual comorbid psychiatric disorders ; and ( 3 ) the interaction between gender and each of the three diagnostic groups . RESULTS Men showed greater intensity of drinking , more alcohol-related symptoms and poorer global alcohol-related outcome .  Younger patients also showed more alcohol-related symptoms . Although the number of comorbid diagnoses was correlated with both the intensity of drinking and the severity of psychopathology , each of the specific comorbid diagnoses accounted for unique variance in outcome . Comorbid drug abuse/dependence was associated with more drinking days and more alcohol-related symptoms . In contrast , the presence of comorbid major depression was associated with lower intensity of drinking . Finally , ASP was associated with poorer global alcohol-related outcome . CONCLUSIONS Outcomes 3 years after alcoholism treatment are related to the presence of specific lifetime comorbid psychiatric diagnoses . Since such disorders may positively influence the course of alcoholism , trials of clinical interventions that target these disorders are warranted AIMS To measure the effect of community nurse follow-up on abstinence and retention rates in the outpatient treatment of alcohol-dependent patients treated with acamprosate . METHODS Recently detoxified alcohol-dependent patients were prescribed acamprosate for 26 weeks and r and omized to either physician-only follow-up , or physician plus regular visits from a community nurse .  Drinking behaviour in the next 26 weeks was assessed at monthly visits to non-blind clinicians . RESULTS The cumulative abstinence duration proportion ( CADP ) was significantly longer in ( P=0.03 ) the subjects who had received community nurse support ( 0.57 ) than in those who had not ( 0.39 ) . This might , in part , be an artefact of the higher retention rate among those followed up by the nurse , in that , the method of calculating CADP allocates 100 % days of drinking for the month before a failed attendance . Differences favouring nurse in the follow-up were seen for time to first drink , and clinical global impression . CONCLUSIONS For recently detoxified alcohol-dependent patients treated with acamprosate , follow-up by a community nurse improves patient retention and probably also improves the 6-month drinking outcome Objective : In spite of the increasing interest in out‐patient treatment programmes for alcoholics , there still exist only a few experimental studies on this issue . In this still ongoing study the efficacy of different behaviour therapy strategies  is 
    Output:
    
Adding an active intervention to usual continuing care seems to improve treatment outcomes .