***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 Background Alcohol screening and brief intervention for unhealthy alcohol use has not been consistently delivered in primary care as part of preventive healthcare . Objective To explore whether telephone-based intervention delivered by a health educator is efficacious in reducing  at-risk drinking among older adults in primary care setting s. Design Secondary analyses of data from a r and omized controlled trial . Participants Subjects r and omized to the intervention arm of the trial ( n = 310 ) . Interventions Personalized risk reports , advice from physicians , booklet about alcohol and aging , and up to three telephone calls from a health educator . All interventions were completed before the three-month follow-up . Measurements Risk outcomes ( at-risk or not at-risk ) at 3 and 12 months after enrollment . Main results In univariate analyses , compared to those who remained at risk , those who achieved not at-risk outcome at 3 months were more likely to be women , Hispanic or non-white , have lower levels of education , consume less alcohol , drink less frequently , and have lower baseline number of risks . In mixed-effects logistic regression models , completing all three health educator calls increased the odds of achieving not at-risk outcome compared to not completing any calls at 3 months ( OR 5.31 ; 95 % CI 1.92–14.7 ; p = 0.001 ) , but not at 12 months ( OR 2.01 ; 95 % CI 0.71–5.67 ; p = 0.18 ) . Conclusions Telephone-based intervention delivered by a health educator was moderately efficacious in reducing at-risk drinking at 3 months after enrollment among older adults receiving a multi-faceted intervention in primary care setting s ; however , the effect was not sustained at 12 months OBJECTIVE : To test the effectiveness of a brief intervention in the reduction of prenatal alcohol consumption  by women when a partner is included . METHODS : R and omized trial of a single session brief intervention given by the study nurse or principal investigator for 304 pregnant women and their partners . The women had positive T-ACE ( Tolerance , Annoyed , Cut down , Eye-opener , an alcohol screening test ) results and were at risk for alcohol consumption while pregnant . All completed initial diagnostic and postpartum interviews . RESULTS : Fewer than 20 % of participants ( median 11.5 weeks of gestation ) were abstinent at study enrollment , averaging more than 1.5 drinks per episode . Nearly 30 % had 2 or more drinks at a time while pregnant . Prenatal alcohol use declined in both the treatment and control groups after study enrollment , based on a 95 % follow-up rate . Factors associated with increased prenatal alcohol use after r and omization included more years of education , extent of previous alcohol consumption , and temptation to drink in social situations . Brief interventions for prenatal alcohol reduced subsequent consumption most significantly for the women with the highest consumption initially ( regression coefficient , b = −0.163 , st and ard error ( b ) = 0.063 , P < .01 ) . Moreover , the effects of the brief intervention were significantly enhanced when a partner participated ( b = −0.932 , st and ard error ( b ) = 0.468 ) , P < .05 ) . CONCLUSION : Pregnant women with the highest levels of alcohol use reduced their drinking most after a brief intervention that included their partners . Recommendations include consistent screening for prenatal alcohol use followed by diagnostic assessment when indicated , and if confirmed by other studies , a patient-partner brief intervention for the heaviest drinkers . LEVEL OF EVIDENCE : Purpose The purpose of this study is to determine the effect at 48 months of a screening and brief patient-centered physician- and nurse practitioner-delivered intervention implemented during a routine primary care visit on the reduction of alcohol consumption by high-risk drinkers . Methods Participants seen in primary care practice s previously r and omized to special intervention ( SI ) or usual care ( UC )  were reconsented for long-term follow-up . From the initial cohort , 63 % reconsented to participate and provided follow-up at 48 months between November 1996 and March 2002 . The data for this paper were analyzed in June 2004 . Results At 48 months , SI participants maintained significant reductions in drinks per week seen at 6 and 12 months . However , there were no longer significant differences in drinks per week , binges per month , percentage of low-risk drinking , relapse rates , and new quits between the SI and UC groups at 48 months that had been seen at earlier follow-up . There was a significant effect of prior low-risk drinking status at 12 months ; those who were low-risk drinkers at 12 months were more likely to stay low-risk drinkers at 48 months regardless of treatment group . Conclusions With a single brief intervention , SI participants had significantly greater reductions in their drinking levels at 6 and 12 months compared to UC participants and maintained the lower-risk levels at 48 months result ing in a reduction in health risk exposure time . However , the significant group differences in treatment effect seen in earlier follow-ups were not maintained Seventy two women drinking 21 units ( 210 g ) or more of alcohol per week were recruited from an opportunistic screening programme in eight English general practice s. The women were r and omized into control and treatment groups . Women in the treatment group received ten minutes advice from their general practitioner to reduce alcohol consumption .  At one year follow-up , when analyzed by intention to treat , women in the treatment group had reduced their alcohol consumption from an average of 35 - 24 units per week . Similar reductions were found in the control group ( from 37 - 27 units per week ) . The lack of evidence for a treatment effect may be explained by contamination of the control group by informal interventions In a controlled evaluation of general practitioner (GP)-based brief intervention , 378 excessive drinkers identified opportunistically by screening in 40 group practice s in metropolitan Sydney were assigned to groups receiving : ( i ) a five-session intervention by the GP ( the Alcoholscreen Program ) ; ( ii ) a single session of 5 minutes ' advice by the GP plus a self-help manual ( minimal intervention ) ; ( iii ) an alcohol-related assessment but no intervention ; ( iv ) neither intervention nor assessment . Among all patients allocated to receive it , the Alcoholscreen Program did not result in a significantly greater reduction in consumption at follow-up than control conditions but patients offered Alcoholscreen reported a significantly greater reduction in alcohol-related problems in the period to 6 months follow-up . A greater proportion of patients who returned for the second Alcoholscreen visit were drinking below recommended levels at follow-up than in the remainder of the sample . There was no evidence that minimal intervention or alcohol-related assessment were effective in reducing alcohol consumption or problems . Implication s for further research into GP-based brief interventions are discussed Home visitation interventions show promise for helping at-risk mothers , yet few programs have been developed and evaluated specifically for alcohol and drug-abusing pregnant women . This study examines outcomes among 216 women enrolled in the Washington State Parent-Child Assistance Program , a three-year intervention program for women who abuse alcohol and drugs during an index pregnancy . Pretest-posttest comparison was made across three sites : the original demonstration ( 1991–1995 ) , and the Seattle and Tacoma replications ( 1996–2003 ) . In the original demonstration , the client group performed significantly better than controls . Compared to the original demonstration , outcomes at replication sites were maintained ( for regular use of contraception and use of reliable method ; and number of subsequent deliveries ) , or improved ( for alcohol/drug treatment completed ; alcohol/drug abstinence ; subsequent delivery unexposed to alcohol/drugs ) . Improved outcomes at replication sites are not attributable to enrolling lower-risk women . Public policies and programs initiated over the study period may have had a positive effect on outcomes . Study findings suggest that this community-based intervention model is effective over time and across venues OBJECTIVE : To determine effectiveness of advice from general practitioners to heavy drinkers to reduce their  excessive alcohol consumption ( 35 U or more a week for men , 21 U or more for women ) . DESIGN : R and omised , controlled double blind trial over 12 months with interim assessment at six months . SETTING : Group practice s ( n = 47 ; list size averaging 10,000 ) recruited from Medical Research Council 's general practice research framework , mostly in rural or small urban setting s. PATIENTS : Patients recruited after question naire survey . Of total of 2571 ( 61.2 % ) of 4203 patients invited for interview who attended , 909 ( 35.4 % ) stated that in past seven days they had drunk above the limits set for study and had not received advice ; they were r and omised to control and treatment groups . INTERVENTIONS : Patients in treatment group were interviewed by general practitioner ( who had had a training session ) and received advice and information about how to reduce consumption and also given a drinking diary . END POINT : Study aim ed at detecting a reduction in proportion of men with excessive alcohol consumption of 30 % in treatment group and 20 % in control group ( for women 40 % and 20 % , respectively ) with a power of 90 % at 5 % level of significance . In addition , corroborative measures such as estimation of gamma-glutamyltransferase activity were included . MEASUREMENTS AND MAIN RESULTS : At one year a mean reduction in consumption of alcohol of 18.2 ( SE 1.5 ) U/week had occurred in treated men compared with a reduction of 8.1 ( 1.6 ) U/week in controls ( p less than 0.001 ) . The proportion of men with excessive consumption at interview had dropped by 43.7 % in the treatment group compared with 25.5 % in controls ( p less than 0.001 ) . A mean reduction in weekly consumption of 11.5 ( 1.6 ) U occurred in treated women compared with 6.3 ( 2.0 ) U in controls ( p less than 0.05 ) , with proportionate reductions of excessive drinkers in treatment and control groups of 47.7 % and 29.2 % respectively . Reduction in consumption increased significantly with number of general practitioner interventions . At one year the mean value for gamma-glutamyltransferase activity had dropped significantly more in treated men ( -2.4 (0.9)IU/l ) than in controls ( + 1.1(1.0)IU/l ; t = 2.7 , p less than 0.01 ) . Reduction in gamma-glutamyltransferase activity tended to increase with number of intervention sessions in men . Changes in gamma-glutamyltransferase activity in women and changes in other indicators in both sexes did not differ significantly between treatment and control groups . CONCLUSIONS : If the results of this study were applied to the United Kingdom intervention by general practitioners could each year reduce to moderate levels the alcohol consumption of some 250000 men and 67500 women who currently drink to excess . General practitioners and other members of the primary health care team should therefore be encouraged to include counselling about alcohol consumption in their preventive activities AIM To analyse gender differences in the efficacy of stepped care brief interventions for general practice patients with alcohol problems . METHODS Data are part of " Stepped Interventions for Problem Drinkers , " in which 10,803 patients from 85 general practitioners were screened using alcohol related question naires ; 408 patients were r and omized ( 32 % were female ) to a control ( booklet only ) or two different intervention groups : stepped care ( feedback , manual , and up to three counselling sessions depending on the success of the previous intervention ) and fixed care ( four sessions ) .  Response rate for the 12 months follow-up was 91.7 % . RESULTS Regression analysis revealed a significant effect size only in women ( P = 0.039 ) . After excluding alcohol dependents and binge drinkers , an effect size ( R(2 ) ) of 0.031 ( P 
    Output:
    
The best evidence was for brief ( 10- to 15-minute ) multicontact interventions .
Evidence was insufficient to draw conclusions about accidents , injuries , or alcohol-related liver problems .
Trials enrolling young adults or college students showed reduced consumption and fewer heavy drinking episodes ( moderate strength of evidence ) .
Little or no evidence of harms was found .
CONCLUSION Behavioral counseling interventions improve behavioral outcomes for adults with risky drinking .