***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: An interactive CD-ROM program design ed to reduce adolescent substance use was developed and evaluated . The program uses video vignettes to teach refusal skills and socially acceptable responses to substance use situations , specifically offers of marijuana . In a r and omized pretest-to-posttest experiment with 74 public school students from six classes in three high schools , significant changes were observed at posttest on ( 1 ) the adolescent 's personal efficacy to refuse the offer of marijuana , ( 2 ) the adolescent 's intention to refuse marijuana if offered , and ( 3 ) the adolescent 's perceptions of the social norms associated with substance use and the importance of respecting another 's decision to refuse a drug offer . In addition , adolescents in the treatment condition were able to recall approximately 50 % of the portrayed refusal strategies . Findings are discussed with regard to the potential benefits of an interactive multimedia approach for conducting substance use interventions We sought to characterize attrition-related characteristics of three subgroups of adults ( i.e. early dropouts , late dropouts , treatment completers ) who had participated in a marijuana-dependence treatment outcome study involving two alternative forms of outpatient group counseling .  Early dropouts were younger , earned less income , were more likely to rent rather than own their domiciles , were less able to pay bills , and had a higher level of psychological distress than was the case with treatment completers . Late dropouts and completers were quite similar on a number of measures ( e.g. , age , income , home ownership , ability to pay bills , psychological stress level , confidence in being abstinent in the future ) , yet the lower rates of abstinence in the late dropouts largely resembled the treatment outcomes of early dropouts . The findings suggest that attrition prevention in the early phase of counseling ought to focus on motivational ambivalence as well as assisting the client in dealing with schedule conflicts or financial impediments to continued involvement . In the later stage of counseling , attrition reduction is more likely to be accomplished through efforts to better underst and and address the client 's dissatisfaction with treatment components delivered at that stage AIMS Our objective was to identify client characteristics and other factors associated with pre-treatment drop-out by people with marijuana dependence . DESIGN AND PARTICIPANTS Data from the Marijuana Treatment Project 's screening assessment were used to examine correlates of pre-treatment drop-out . Information from all eligible study participants ( n = 813 ) ( i.e. those who were interested in receiving treatment for their marijuana dependence and were determined to be eligible for the r and omized treatment efficacy trial ) was used to examine differences between the 450 participants who initiated treatment ( by enrolling in the trial ) and the 363 individuals who declined enrollment . SETTING The study was conducted at three community-based outpatient treatment facilities in Farmington , CT , Seattle , WA and Miami , FL . MEASUREMENTS The information gathered in the screening interview included demographic characteristics , residential stability variables , employment and education history and referral source . Substance use variables included the number of days and the number of times per day marijuana was used , self-perceived dependence on marijuana , alcohol or other drugs , other drug use history and current treatment ( i.e. substance abuse , medical , psychiatric ) situation . FINDINGS Stepwise logistic regression was conducted to confirm variables associated with treatment initiation in bivariate analyses . Pre-treatment drop-out was associated with being younger , unmarried , unemployed , less educated and Asian American or Native American . It was also associated with self-perceived dependence on marijuana and use of other drugs . CONCLUSIONS By recognizing demographic and substance use factors that may serve as barriers for individuals accessing treatment for marijuana dependence , clinicians may target clients with these characteristics proactively to encourage treatment initiation and subsequent attendance The effects of fasting on the intake and subjective effects of marijuana were studied in five marijuana smokers . A within-subjects design was used in which subjects smoked either active ( 0.8 and 3.6 % THC ) or placebo ( 0.0 % THC ) marijuana after eating normally or after fasting for 24 hr . Six experimental sessions were conducted in a r and omized order . Each 3-hr . session consisted of two periods : a sampling period in which subjects took 4 controlled puffs from a cigarette of a given potency , followed about one hour later by a 30-min . self-administration period , in which subjects could smoke as much or as little of the sample d marijuana as desired . Subjective and physiological measures ( i.e. , carbon monoxide level and heart rate ) were assessed before and 5 , 20 , and 60 min . after the four puffs during the sampling period . During the self-administration period , the number of puffs taken was recorded . Dose-dependent effects of marijuana , such as elevated heart rate and “ high ” ratings , were observed during the sampling period , but these effects of marijuana were not affected by the feeding manipulation . Subjects varied widely in their  marijuana self-administration  , but self-administration was not systematic ally affected by fasting . We conclude that an acute period of food deprivation does not affect the mood-altering effects of different potencies of marijuana . We could not adequately demonstrate whether fasting increases the reinforcing efficacy of marijuana , since self-administration rate of active marijuana did not exceed that of placebo marijuana self-administration One hundred and fifty five drug-dependent women in an urban hospital emergency room in Detroit , Michigan , were the subjects for this 3-year exploratory field study . Subjects were women who told the emergency room staff that while they wanted assistance with their presenting health problems , they wanted no assistance with their drug addiction . The women were r and omly assigned to either the experimental or control study group . Both groups received a pretest in the emergency room , a posttest between 8 and 12 weeks after their emergency room visit , and a follow-up test 6 months after the posttest . In addition , the experimental women were seen by project nurses , primarily in their homes , for a maximum of eight visits on a once-a-week basis . The experimental women were treated using " Personalized Nursing , " a nursing intervention model , which focused on providing assistance for client-identified concerns . It was hypothesized that interaction with the Personalized Nursing Intervention Model would be associated with : a decrease in daily drug cost and a decrease in perceived stress . Results show that while there were no differences between the study groups at the pretest interview , the experimental group reported a lower daily drug cost ( F(1 , 95 ) = 2.90 ; p = 0.09 ) , a lower daily heroin cost ( U = 165 ; p = .01 ) , less perceived stress ( F(1 , 84 ) = 3.00 ; p = .09 ) and emotional distress ( F(1 , 83 ) = 3.70 ; p = .06 ) than control subjects at the 8-week posttest . The experimental subjects also reported less perceived stress ( t(65 ) = -2.35 ; p = .02 ) at 6-month follow-up than control subjects . It was found that results could be improved if members of the experimental clients ' social networks were treated simultaneously and if project nurses were correctly utilizing the model . Implication s for substance abuse treatment programs are discussed . The encouraging results of this exploratory study warrant follow-up and replication This study investigated the efficacy of brief strategic family therapy ( BSFT ) with Hispanic behavior problem and drug using youth , an underrepresented population in the family therapy research literature . One hundred twenty-six Hispanic families with a behavior problem adolescent were r and omly assigned to 1 of 2 conditions : BSFT or group treatment control ( GC ) . Results showed that , compared to GC cases , BSFT cases showed significantly greater pre- to post-intervention improvement in parent reports of adolescent conduct problems and delinquency , adolescent reports of marijuana use , and observer ratings and self reports of family functioning . These results extend prior findings on the efficacy of family interventions to a difficult to treat Hispanic adolescent sample BACKGROUND The present study addresses diffusion of a psychosocial-based substance abuse prevention program , including : ( a ) teacher adoption , implementation , and maintenance ; ( b ) teacher characteristics associated with implementation ; ( c ) the relationship between integrity of program delivery and program outcomes ; and ( d ) the effectiveness of teacher training and school principal involvement in increasing implementation . METHODS Participants were teachers ( n = 60 ) , school principals ( n = 25 ) , and fifth- grade students ( n = 1147 ) from four Los Angeles area school districts . Districts were r and omly assigned to an intensive or brief teacher training condition . Schools were r and omly assigned to a principal-intervention or a no-principal-intervention condition . Assessment s included teacher and principal self-reports , classroom observations of program delivery , and evaluation of immediate program outcomes . RESULTS During the first year , 78 % of trained teachers implemented one or more program lessons . During the second year , only 25 % maintained implementation of the program . Implementors reported fewer years of teaching experience and stronger self-efficacy , enthusiasm , preparedness , teaching methods compatibility , and principal encouragement than did nonimplementors . The principal intervention increased rates of implementation , but the intensive teacher training did not . Integrity of program delivery was positively associated with immediate program outcomes . CONCLUSIONS Program implementation was highly variable , suggesting that widespread teacher use of psychosocial-based programs can not be taken for granted . Strategies for increasing implementation and maintenance need to be developed R and om assignment was made of 182 clinical ly referred marijuana- and alcohol-abusing adolescents to one of three treatments : multidimensional family therapy ( MDFT ) , adolescent group therapy ( AGT ) , and multifamily educational intervention ( MEI ) . Each treatment represented a different theory base and treatment format . All treatments were based on a manual and were delivered on a once-a-week outpatient basis . The therapists were experienced community clinicians trained to model-specific competence prior to the study and then supervised throughout the clinical trial . A theory-based multimodal assessment strategy measured symptom changes and prosocial functioning at intake , termination , and 6 and 12 months following termination . Results indicate improvement among youths in all three treatments , with MDFT showing superior improvement overall . MDFT participants also demonstrated change at the 1-year follow-up period in the important prosocial factors of school/academic performance and family functioning as measured by behavioral ratings . Results support the efficacy of MDFT , a relatively short-term , multicomponent , multitarget , family-based intervention in significantly reducing adolescent drug abuse and facilitating adaptive and protective developmental processes The increasing dem and for cannabis dependence treatment has led to the identification of significant gaps in the knowledge of effective interventions . A r and omized controlled trial of brief cognitive-behavioral interventions ( CBT ) for cannabis dependence was undertaken to address this issue . A total of 229 participants were assessed and allocated to either a 6-session CBT program , a single-session brief intervention , or a delayed-treatment control group . This paper demonstrates that individuals with cannabis use disorder will present for a brief intervention program . While they report similar patterns of cannabis use to nontreatment sample s , they report a range of serious health and psychosocial consequences . While they appear relatively socially stable , they typically demonstrated severe cannabis dependence and significantly elevated levels of psychological distress , with the most commonly cited reason for cannabis use being stress relief . There were clinical ly relevant gender differences among the sample . This study provides more evidence of the dem and for , and nature of issues relevant to , interventions for cannabis use disorders , and supports the need for further research into how best to assist individuals with these disorders We have examined whether practitioner ratings ( immediately post-intervention ) or other recorded characteristics of a single-session 1-hour motivational intervention were predictive of 3-month cannabis use outcome . In the context of a cluster r and omized trial involving 200 non help-seeking illegal drug users ( age range 16 - 20 ) , 105 were r and omized to the intervention , of whom 97 ( 92 % ) were interviewed for followup at 3 months , 96 of whom were current cannabis users at study entry . Six intervention characteristics and seven practitioner ratings as well as patterns of self-motivational statements were investigated in relation to substantial change in use , ( which was defined as cessation or reduction by more than 50 % ) . Both practitioner ratings post-session , and also the subject 's own elicited self-motivational statements , were found to be predictive of outcome 3 months later . The strongest predictor of substantial change , however , was simply whether change had been discussed during the session . On the basis of the above findings , it does indeed appear possible for outcome to be predicted by the motivational interviewing practitioner immediately following delivery of the intervention , on the basis of simple observations and ratings . This area warrants more specific study This study presents one-year follow-up data from an evaluation study testing the effectiveness of a cognitive-behavioral substance abuse prevention approach which emphasizes the teaching of social resistance skills within the larger context of an intervention design ed to enhance general social and personal competence . The follow-up study involved 998 eighth grade rs from 10 suburban New York junior high schools . Two schools were assigned to each of the following conditions ( a ) peer-led intervention , ( b ) peer-led intervention with booster sessions , ( c ) teacher-led intervention , ( d ) teacher-led intervention with booster sessions , and ( e ) control . The original intervention was implemented in the seventh grade ; the booster intervention was implemented during the eighth grade . Results indicate that this type of prevention strategy , when implemented by peer leaders in the seventh grade and when additional booster sessions are provided during the eighth grade , can reduce tobacco , alcohol , and marijuana use . Similar effects are evident for females when the prevention program is implemented with fidelity by classroom teachers . Moreover , the prevention program is also capable of producing a significant impact on several hypothesized mediating variables OBJECTIVE To evaluate the long-term efficacy of a school-based approach to drug abuse prevention . DESIGN R and omized trial involving 56 public schools that received the prevention program with annual 
    Output:
    
The six included studies suggested that counseling approaches might have beneficial effects for the treatment of cannabis dependence .
Group and individual sessions of cognitive behavioral therapy ( CBT ) had both efficacy for the treatment of cannabis dependence and associated problems , CBT produced better outcomes than a brief intervention when CBT was delivered in individual sessions .
Abstinence rates were relatively small overall but favored the individual CBT 9-session ( or more ) condition .
All included trials reported a statistically significant reductions in frequency of cannabis use and dependence symptoms .
But other measures of problems related to cannabis use were not consistently different .
The studies comparing different therapeutic modalities raise important questions about the duration , intensity and type of treatment .
However , the low abstinence rate indicated that cannabis dependence is not easily treated by psychotherapies in outpatient setting