***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: Abstract Aims A pilot r and omized controlled trial ( RCT ) to assess the feasibility and potential efficacy of assertive community treatment ( ACT ) in adults with alcohol dependence . Methods Single blind , individually r and omized , pilot RCT of 12 months of ACT plus treatment as usual ( TAU ) versus TAU alone in adults ( age 18 + years ) with alcohol dependence and a history of previous unsuccessful alcohol treatment attending specialist community alcohol treatment services . ACT aim ed to actively engage participants for 12 months with assertive , regular , minimum weekly contact . ACT was combined with TAU . TAU comprised access to the full range of services provided by the community teams . Primary outcome is mean drinks per drinking day and percent days abstinent at 12 months follow up . Analysis of covariance was conducted using 80 % confidence intervals , appropriate in the context of a pilot trial . Results A total of 94 participants were r and omized , 45 in ACT and 49 in TAU . Follow-up was achieved with 98 and 88 % , respectively at 12 months . Those in ACT had better treatment engagement , and were more often seen in their homes or local community than TAU participants . At 12 months the ACT group had more problems related to drinking and lower quality of life than TAU but no differences in drinking measures . The ACT group had a higher percentage of days abstinent but lower quality of life at 6 months . The ACT group had less unplanned healthcare use than TAU . Conclusions An trial of ACT was feasible to implement in an alcohol dependent treatment population . Trial registration IS RCT BACKGROUND People with mental illness and substance use disorder are over-represented in prisons .  Injury-related mortality is elevated in people released from prison , and both mental illness and substance use disorder are risk factors for injury . Effective care coordination during the transition between criminal justice and community service providers improves health outcomes for people released from prison . However , the health outcomes and support needs of people with dual diagnosis ( co-occurring mental illness and substance use disorder ) released from prison are poorly understood . Here we aim to examine the association between dual diagnosis and non-fatal injury in adults released from prison . METHODS  Pre-release interview data  collected between Aug 1 , 2008 , and July 31 , 2010 , from a representative sample of sentenced adults ( ≥18 years ) in Queensl and , Australia , were linked , retrospectively and prospect ively , to person-level , state-wide emergency department and hospital records . We identified dual diagnoses from inpatient , emergency department , and prison medical records . We modelled the association between mental health status and all injury result ing in hospital contact by fitting a multivariate Cox regression , adjusting for sociodemographic , health , and criminogenic covariates , and replacing missing covariate data by multiple imputation . FINDINGS In 1307 adults released from prison , there were 2056 person-years of follow-up ( median 495 days , IQR 163 - 958 ) . The crude injury rates were 996 ( 95 % CI 893 - 1112 ) per 1000 person-years for the dual diagnosis group , 538 ( 441 - 657 ) per 1000 person-years for the mental illness only group , 413 ( 354 - 482 ) per 1000 person-years for the substance use disorder only group , and 275 ( 247 - 307 ) per 1000 person-years for the no mental disorder group . After adjusting for model covariates , the dual diagnosis ( adjusted hazard rate ratio 3·27 , 95 % CI 2·30 - 4·64 ; p<0·0001 ) and mental illness only ( 1·87 , 1·19 - 2·95 ; p=0·0071 ) groups were at increased risk of injury after release from prison compared with the group with no mental health disorders . INTERPRETATION People released from prison experience high rates of injury compared with the general population . Among people released from prison , dual diagnosis is associated with an increased risk of injury . Contact with the criminal justice system is a key opportunity to prevent subsequent injury morbidity in people with co-occurring mental health disorders . Engagement with integrated psychiatric and addiction treatment delivered without interruption during the transition from prison into the community might prevent the injury-related disparities experienced by this vulnerable group . The development of targeted injury prevention strategies for people with dual diagnosis released from prison is warranted . FUNDING National Health and Medical Research Council 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 At three community mental health centers ( CMHCs ) in Indiana , 167 clients at risk for rehospitalization were r and omly assigned to experimental groups receiving assertive case management ( ACM ) or to control groups eligible to receive all other aftercare services at the centers . During a six-month follow-up period , experimental clients received an average of one visit a week from the ACM team , usually in the client 's home or in community setting s. Overall , ACM clients were rehospitalized an average of 9.2 days , significantly less than the 30.8 days for controls . In two of the three centers , significant rehospitalization differences were also found between ACM and control groups . No differences were found between groups in quality of life , medication compliance , involvement in CMHC programs , or contacts with the legal system in any of the centers . The most cost-effective center had savings of about + 5,500 for each ACM client We conducted secondary analyses of data from a r and omized trial testing the effectiveness of Assertive Community Treatment ( ACT ) in delivery of integrated dual disorder treatment ( IDDT ) to explore the impact of IDDT delivered through ACT teams compared with st and ard clinical case management for dually-disordered persons with and without antisocial personality disorder ( ASPD ) . This analysis included 36 individuals with ASPD and 88 individuals without ASPD . Participants with ASPD assigned to ACT showed a significantly greater reduction in alcohol use and were less likely to go to jail than those in st and ard clinical case management , whereas participants without ASPD did not differ between the 2 case management approaches . There were no significant differences for other substance use or criminal justice outcomes . This study provides preliminary evidence that persons with co-occurring serious mental illness , substance use disorders , and ASPD may benefit from delivery of IDDT through ACT teams OBJECTIVE : This study analyzed data from a r and omized trial to examine the impact on medication adherence of integrated treatment delivered via assertive community treatment ( ACT ) versus st and ard clinical case management ( SCCM ) . METHOD : Data from the original study included 198 study participants with co-occurring psychotic and substance use disorders who were r and omly assigned to receive integrated treatment via ACT or SCCM and were followed for 3 years . We applied mixed-effects logistic regression to estimate group ( ACT vs. SCCM ) by time effects on a self-report measure of medication adherence . Adherence was dichotomized as 20 % or more missed medication days ( “ poor adherence ” ) versus less than 20 % missed medication days ( “ adequate adherence ” ) . RESULTS : Participants who were assigned to ACT reported significant improvement in medication adherence compared with those assigned to SCCM . CONCLUSIONS : Integrated treatment delivered via ACT may benefit persons with co-occurring psychotic and substance use disorders who are poorly adherent to medications BACKGROUND People with severe mental illness and substance use disorders ( dual disorder ) often have considerable contact with the criminal justice system . AIMS To test the effects of client characteristics on six criminal justice outcomes among homeless ( at intake ) people with mental illness and substance misuse disorders . METHODS The sample was of participants in a r and omized controlled trial comparing st and ard treatment , assertive community treatment ( ACT ) and integrated treatment ( IT ) . Data were analysed using hierarchical logistic regression . RESULTS Half the sample was arrested and a quarter incarcerated during the two-year follow-up period . The regression models explained between 22 % and 35 % of the variance of the following criminal justice measures : ( 1 ) major offences , ( 2 ) minor offences , ( 3 ) substance-use-related offences , ( 4 ) incarcerations , ( 5 ) arrests , and ( 6 ) summons . Prior criminal behaviour was the strongest predictor of all of the dependent variables ; in general , demographic and diagnostic variables were not . Similarly , neither the type nor the amount of mental health treatment received predicted subsequent criminal behaviour . CONCLUSION Elsewhere the authors have shown that ACT and IT had advantages for health and stability of accommodation but these analyses suggest that more specialized interventions are needed to reduce criminal behaviour in dual disorder individuals OBJECTIVE The ACCESS trial examined the 12-month effectiveness of continuous therapeutic assertive community treatment ( ACT ) as part of integrated care compared to st and ard care in a catchment area comparison design in patients with schizophrenia spectrum disorders treated with quetiapine immediate release . METHOD Two catchment areas in Hamburg , Germany , with similar population size and health care structures were assigned to offer 12-month ACT as part of integrated care ( n = 64 ) or st and ard care ( n = 56 ) to 120 patients with first- or multiple-episode schizophrenia spectrum disorders ( Structured Clinical Interview for DSM-IV Axis I Disorders criteria ) ; multiple-episode patients were restricted to those with a history of relapse due to medication nonadherence . The primary outcome was time to service disengagement . Secondary outcomes comprised medication nonadherence , improvements of symptoms , functioning , quality of life , satisfaction with care from patients ' and relatives ' perspectives , and service use data . The study was conducted from April 2005 to December 2008 . RESULTS 17 of 120 patients ( 14.2 % ) disengaged with service , 4 patients ( 6.3 % ) in the ACT and 13 patients ( 23.2 % ) in the st and ard care group . The mean Kaplan-Meier estimated time in service was 50.7 weeks in the ACT group ( 95 % CI , 49.1 - 52.0 ) and 44.1 weeks in the st and ard care group ( 95 % CI , 40.1 - 48.1 ) . This difference was statistically significant ( P = .0035 ) . Mixed models repeated measures indicated larger improvements for ACT compared to st and ard care regarding symptoms ( P < . 01 ) , illness severity ( P < . 001 ) , global functioning ( P < . 05 ) , quality of life ( P < . 05 ) , and client satisfaction as perceived by patients and family ( both P < . 05 ) . Logistic regression analyses revealed that ACT was associated with a higher likelihood of being employed/occupied ( P = .001 ) , of living independently ( P = .007 ) , and of being adherent with medication ( P < . 001 ) and a lower likelihood of persistent substance misuse ( P = .027 ) . CONCLUSIONS Compared to st and ard care , intensive therapeutic ACT as part of integrated care could improve 1-year outcome . Future studies need to address in which setting s these improvements can be sustained . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01081418 CONTEXT Intensive early treatment for first-episode psychosis has been shown to be effective . It is unknown if the positive effects are sustained for 5 years . OBJECTIVE To determine the long-term effects of an intensive early-intervention program ( OPUS ) for first-episode psychotic patients . DESIGN Single-blinded , r and omized , controlled clinical trial of 2 years of an intensive early-intervention program vs st and ard treatment . Follow-up periods were 2 and 5 years . SETTING Copenhagen Hospital Corporation and Psychiatric Hospital , Aarhus , Denmark . Patients A total of 547 patients with a first episode of psychosis . Of these , 369 patients were participating in a 2-year follow-up , and 301 were participating in a 5-year follow-up . A total of 547 patients were followed for 5 years . INTERVENTIONS Two years of an intensive early-intervention program vs st and ard treatment . The intensive early-intervention treatment consisted of assertive community treatment , family involvement , and social skills training . St and ard treatment offered contact with a community mental health center . MAIN OUTCOME MEASURES Psychotic and negative symptoms were recorded . Secondary outcome measures were use of services and social functioning . RESULTS Analysis was based on the principles of intention-to-treat . Assessment was blinded for previous treatment allocation . At the 5-year follow-up , the effect of treatment seen after 2 years ( psychotic dimension odds ratio [ OR ] , -0.32 ; 95 % confidence interval [ CI ] , -0.58 to -0.06 ; P = .02 ; negative dimension OR , -0.45 ; 95 % CI , -0.67 to -0.22 ; P = .001 ) had equalized between the treatment groups . A significantly smaller percentage of patients from the experimental group were living in supported housing ( 4 % vs 10 % , respectively ; OR , 2.3 ; 95 % CI , 1.1 - 4.8 ; P = .02 ) and were hospitalized fewer days ( mean , 149 vs 193 days ; mean difference , 44 days ; 95 % CI , 0.15 - 88.12 ; P = .05 ) during the 5-year period . CON 
    Output:
    
Higher fidelity to the ACT model appears to improve outcomes .
Substance use reduced only in half of the data sets , of which only one showed a significant reduction in the ACT group .
Overall , ACT is a promising approach that may be useful for promoting treatment engagement for patients with SUD .
According to earlier studies on patients with severe mental illness , patients with high inpatient service use benefit most from this assertive approach .
We hypothesize that a similar high need user group among patients with SUD might benefit most from ACT .