***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 We sought to examine the relation between cannabis abuse and the symptomatic course of recent-onset schizophrenia and related disorders . DESIGN A prospect i ve cohort study over a year using monthly Brief Psychiatric Rating Scale assessment s. PARTICIPANTS  Cannabis-abusing patients ( n = 24 ) were compared with nonabusers ( n = 69 ) . Eleven patients were mild and 13 were heavy cannabis-abusing patients . RESULTS Significantly more and earlier psychotic relapses occurred in the cannabis-abusing group ( P = .03 ) . This association became stronger when mild and heavy cannabis abuse were distinguished ( P = .002 ) . No confounding effect of other variables , eg , other street drugs , was found . In all but one patient , cannabis abuse preceded the onset of the first psychotic symptoms for at least 1 year . CONCLUSIONS Cannabis abuse and particularly heavy abuse can be considered a stressor eliciting relapse in patients with schizophrenia and related disorders and possibly a premorbid precipitant Integrated mental health and substance abuse treatment within an assertive community treatment ( ACT ) approach was compared to that within a st and ard case management approach for 223 patients with dual disorders over three years . ACT patients showed greater improvements on some measures of substance abuse and quality of life , but the groups were equivalent on most measures , including stable community days , hospital days , psychiatric symptoms , and remission of substance use disorder 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 OBJECTIVE Comorbidity of substance abuse disorders with schizophrenia is associated with a greater risk for serious illness complications and poorer outcome . Method ologically sound studies investigating treatment approaches for patients with these disorders are rare , although recommendations for integrated and comprehensive treatment programs abound . This study investigates the relative benefit of adding an integrated psychological and psychosocial treatment program to routine psychiatric care for patients with schizophrenia and substance use disorders . METHOD The authors conducted a r and omized , single-blind controlled comparison of routine care with a program of routine care integrated with motivational interviewing , cognitive behavior therapy , and family or caregiver intervention . RESULTS The integrated treatment program result ed in significantly greater improvement in patients ' general functioning than routine care alone at the end of treatment and 12 months after the beginning of the study . Other benefits of the program included a reduction in positive symptoms and in symptom exacerbations and an increase in the percent of days of abstinence from drugs or alcohol over the 12-month period from baseline to follow-up . CONCLUSIONS These findings demonstrate the effectiveness of a program of routine care integrated with motivational interviewing , cognitive behavior therapy , and family intervention over routine psychiatric care alone for patients with comorbid schizophrenia and alcohol or drug abuse or dependence OBJECTIVES The feasibility and effectiveness of treating homeless mentally ill chemical abusers in community residences compared with a therapeutic community were evaluated . METHODS A total of 694 homeless mentally ill chemical abusers were r and omly referred to two community residences or a therapeutic community . All programs were enhanced to treat persons with dual diagnoses . Subjects ' attrition , substance use , and psychopathology were measured at two , six , and 12 months . RESULTS Forty-two percent of the 694 referred subjects were admitted to their assigned program and showed up for treatment , and 13 percent completed 12 months or more . Clients retained at both types of program showed reductions in substance use and psychopathology , but reductions were greater at the therapeutic community . Compared with subjects in the community residences , those in the therapeutic community were more likely to be drug free , as measured by urine analysis and self-reports , and showed greater improvement in psychiatric symptoms , as measured by the Center for Epidemiological Studies --Depression Scale and the Brief Psychiatric Rating Scale . Their functioning also improved , as measured by the Global Assessment of Functioning scale . CONCLUSIONS Homeless mentally ill chemical abusers who are retained in community-based residential programs , especially in therapeutic communities , can be successfully treated Homeless adults with both a serious mental illness and substance dependence ( N = 276 ) were r and omly assigned to : ( 1 ) a social model residential program providing integrated mental health and substance abuse treatment ; ( 2 ) a community-based nonresidential program using the same social model approach ; or ( 3 ) a control group receiving no intervention but free to access other community services . Interventions were design ed to provide 3 months of intensive treatment , followed by 3 months of nonresidential maintenance . Subjects completed baseline interviews prior to r and omization and reinterviews 3 , 6 , and 9 months later . Results showed that , while substance use , mental health , and housing outcomes improved from baseline , subjects assigned to treatment conditions differed little from control subjects . Examination of the relationship between length of treatment exposure and outcomes suggested that residential treatment had positive effects on outcomes at 3 months , but that these effects were eroded by 6 months BACKGROUND There is a well-recognized association between substance use and psychotic disorders , sometimes described as ' dual diagnosis ' . The use of substances by people with psychosis has a negative impact in terms of symptoms , longitudinal course of illness and psychosocial adjustment . There are few vali date d treatments for such individuals , and those that do exist are usually impracticable in routine clinical setting s. The present study employs a r and omized controlled experimental design to examine the effectiveness of a manualized group-based intervention in helping patients with dual diagnosis reduce their substance use . METHOD The active intervention consisted of weekly 90-min sessions over 6 weeks . The manualized intervention was tailored to participants ' stage of change and motivations for drug use . The control condition was a single educational session . RESULTS Sixty-three subjects participated , of whom 58 ( 92 % ) completed a 3-month follow-up assessment of psychopathology , medication and substance use . Significant reductions in favour of the treatment condition were observed for psychopathology , chlorpromazine equivalent dose of antipsychotics , alcohol and illicit substance use , severity of dependence and hospitalization . CONCLUSIONS It is possible to reduce substance use in individuals with psychotic disorders , using a targeted group-based approach . This has important implication s for clinicians who wish to improve the long-term outcome of their patients BACKGROUND Comorbid substance misuse in people with schizophrenia is associated with poor clinical and social outcomes . There are few studies of psychological treatments for this population and little long-term follow-up of their benefits . AIMS To investigate symptom , substance use , functioning and health economy outcomes for patients with schizophrenia and their carers 18 months after a cognitive-behavioural treatment ( CBT ) programme .  METHOD Patients with dual diagnosis from a r and omised controlled trial of motivational intervention , individual CBT and family intervention were assessed on multiple outcomes at 18-month follow-up . Carers were assessed on symptom , functioning and needs over 12 months . Health economy data were collected over 18 months . RESULTS There were significant improvements in patient functioning compared with routine care over 18 months . No significant differences between treatment groups were found in carer or cost outcomes . CONCLUSIONS The treatment programme was superior to routine care on outcomes relating to illness and service use , and the cost was comparable to the control treatment OBJECTIVE Clients with co-occurring severe mental and substance use disorders are at high risk of institutionalization and other adverse outcomes . Although integrated mental health and substance abuse treatment is becoming a st and ard clinical approach for such clients , the optimal method for delivering integrated treatment remains unclear . METHOD This study compared integrated treatment delivered within two different models of community-based case management ( assertive community treatment and st and ard clinical case management ) .  A total of 198 clients in two urban sites who had co-occurring disorders and were homeless or unstably housed were r and omly assigned to one of two treatment conditions and were followed for three years . RESULTS Participants in both treatment conditions improved over time in multiple outcome domains , and few differences were found between the two models . Decreases in substance use were greater than would be expected given time alone . At the site that had higher rates of institutionalization , clients who received st and ard case management were more likely to be institutionalized . However , in the site that had lower rates of institutionalization , no differences in the rate of institutionalization were found between the two treatment conditions . CONCLUSIONS Integrated treatment can be successfully delivered either by assertive community treatment or by st and ard clinical case management This study examines the rationale for and relative effectiveness of three intervention models for treating people with severe mental illness and substance abuse disorders :  Twelve Step recovery , behavioral skills training , and intensive case management . Using clinical trial methods , 132 dually diagnosed clients were assigned to three service approaches . Changes in client psychosocial outcomes , and psychiatric and substance abuse symptomatology were tracked over a 24-month period . Differential effectiveness was evident , with clients in the behavioral skills group demonstrating the most positive and significant differences in psychosocial functioning and symptomatology , compared with the Twelve Step recovery approach . However , the case management intervention also result ed in several positive and important differences compared with the Twelve Step recovery approach . We also found significant changes over time , not only at 6 months but increasingly positive changes in psychosocial functioning at 12 and 18 months as well . These results underscore the need for clinical trials to further examine the relative cost effectiveness of treatment approaches for dually disordered clients and to incorporate means of assessing subgroup differences so that the interventions being tested can be further refined and targeted to a broad set of needs among the dually diagnosed CONTEXT Drug abuse by people with severe mental disorder is a significant public health problem for which there is no empirically vali date d treatment . OBJECTIVE To evaluate the efficacy of a new behavioral treatment for drug abuse in this population : Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness ( BTSAS ) . DESIGN Participants were r and omly assigned to 6 months of treatment in either BTSAS or a manualized control condition : Supportive Treatment for Addiction Recovery ( STAR ) . SETTING Treatment was conducted in community-based outpatient clinics and a Veterans Affairs medical center in Baltimore , Md. PARTICIPANTS Participants were 129 stabilized out patients meeting DSM criteria for drug dependence ( cocaine , heroin , or cannabis ) and serious mental illness : 39.5 % met DSM-IV criteria for schizophrenia or schizoaffective disorder ; 55.8 % , for major affective disorders ; and the remainder met criteria for severe and persistent mental illness and other Axis I disorders . INTERVENTIONS Both treatments were administered by trained health care professionals in small groups , twice a week for 6 months . The BTSAS program is a social learning intervention that includes motivational interviewing , a urinalysis contingency , and social skills training . The control condition , STAR , is a supportive group discussion treatment . Main Outcome Measure The primary outcome measure was urinalysis results from twice-weekly treatment sessions . RESULTS The BTSAS program was significantly more effective than STAR in percentage of clean urine test results , survival in treatment , and attendance at sessions . The BTSAS program also had significant effects on important community-functioning variables , including hospitalization ; money available for living expenses ; and quality of life . CONCLUSIONS The BTSAS program is an efficacious treatment . Further work needs to be done to increase the proportion of eligible patients who are able to become engaged in treatment Faced with many patients with comorbid severe mental illness and substance use disorders , a university-affiliated , inner-city community mental health center and a psychosocial rehabilitation center initiated this clinical trial assessing a program to care for these patients . Fifty-four patients , age 18 to 10 , with either schizophrenia or major affective disorder and a substance use disorder were r and omly assigned to usual community mental health center and rehabilitation services with or without an innovative group and intensive case management program . One-year follow-ups detected no significant advantages on patient outcomes for adding the innovative program to usual services . Failure to engage patients in the experimental program posed a major and enduring barrier to treatment , despite intensive case management . Future efforts must give greater consideration to effective engagement techniques and patients ' readiness for active treatment The objective of this study was to evaluate the efficacy and safety of olanzapine in patients with schizophrenia and comorbid substance abuse disorders . Thirty patients who met DSM-IV criteria for schizophrenia or schizoaffective disorder as well as criteria for substance abuse or substance dependence , were treated in a 12-month prospect i ve , open-label trial of olanzapine . Patients were evaluated with multiple efficacy and safety 
    Output:
    
Contingency management was only effective while active .
Pharmacological interventions appeared effective , but lacked r and omized controlled trials ( RCTs ) .
Psychosocial interventions , e.g. motivational interviewing and cognitive behavior therapy ( CBT ) , were ineffective in most studies with cannabis as a separate outcome , but effective in studies that grouped cannabis together with other substance use disorders .
Insufficient evidence exists on treating this form of dual-diagnosis patients .