You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Moderating drinking by correspondence: an evaluation of a new method of intervention.
Abstract 1:
Recognizing the need to offer alternative methods of brief interventions , this study developed correspondence treatments for low-dependent problem drinkers and evaluated their impact . One hundred and twenty-one problem drinkers were recruited by media advertisements and were r and omly allocated to a full cognitive-behavioural treatment programme ( CBT ) or to a minimal intervention condition ( MI ) that gave information regarding alcohol misuse and instructions to record drinking++ . As predicted , CBT was more effective than MI in reducing alcohol consumption over the 4-month controlled trial period . CBT produced a 50 % fall in consumption , bringing the average intake of subjects within recommended maximum levels . Treatment gains at 6 months were well maintained to 12 months . High levels of consumer satisfaction , a high representation of women and a substantial participation from isolated rural areas attested to the feasibility of the correspondence programme as an alternative treatment . However , some drinking occasions still involved high intake for a significant subgroup of subjects , and this issue will be addressed in future programmes . The results supported the use of correspondence delivery as a means of promoting early engagement and equity of access between city and country areas


Title 2:
An experimental test of telephone aftercare contacts with alcoholics.
Abstract 2:
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


Title 3:
Rehabilitation for convicted drinking drivers (second offenders): effects on mortality.
Abstract 3:
The mortality experience of convicted drinking drivers ( second offenders ) ( N = 347 ) r and omly assigned to rehabilitation and control groups in two Ontario cities was examined . Over a follow-up period ranging between 8 and 13 years , 14 ( 11.0 % ) of the controls and 17 ( 7.7 % ) of the rehabilitation group died . Direct comparisons of the r and omly assigned control and treatment groups revealed a tendency for lower total mortality and significantly lower mortality from accidental and violent death in those assigned to rehabilitation . Additional comparisons involving a combined rehabilitation group ( N = 487 ) ( rehabilitation participants r and omly and not r and omly assigned ) confirmed these observations


Title 4:
A randomized trial of treatment options for alcohol-abusing workers.
Abstract 4:
BACKGROUND Employee-assistance programs sponsored by companies or labor unions identify workers who abuse alcohol and refer them for care , often to inpatient rehabilitation programs . Yet the effectiveness of inpatient treatment , as compared with a variety of less intensive alternatives , has repeatedly been called into question . In this study , anchored in the work site , we compared the effectiveness of m and atory in-hospital treatment with that of required attendance at the meetings of a self-help group and a choice of treatment options . METHODS We r and omly assigned a series of 227 workers newly identified as abusing alcohol to one of three rehabilitation regimens : compulsory inpatient treatment , compulsory attendance at Alcoholics Anonymous ( AA ) meetings , and a choice of options . Inpatient backup was provided if needed . The groups were compared in terms of 12 job-performance variables and 12 measures of drinking and drug use during a two-year follow-up period . RESULTS All three groups improved , and no significant differences were found among the groups in job-related outcome variables . On seven measures of drinking and drug use , however , we found significant differences at several follow-up assessment s. The hospital group fared best and that assigned to AA the least well ; those allowed to choose a program had intermediate outcomes . Additional inpatient treatment was required significantly more often ( P less than 0.0001 ) by the AA group ( 63 percent ) and the choice group ( 38 percent ) than by subjects assigned to initial treatment in the hospital ( 23 percent ) . The differences among the groups were especially pronounced for workers who had used cocaine within six months before study entry . The estimated costs of inpatient treatment for the AA and choice groups averaged only 10 percent less than the costs for the hospital group because of their higher rates of additional treatment . CONCLUSIONS Even for employed problem drinkers who are not abusing drugs and who have no serious medical problems , an initial referral to AA alone or a choice of programs , although less costly than inpatient care , involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse


Title 5:
The 'pressures to change' approach to working with the partners of heavy drinkers.
Abstract 5:
The ' Pressures to Change ' approach to working with the partners of drinkers is a structured procedure for promoting change in resistant drinkers . In this study 22 women and one man were r and omly allocated to two treatment conditions and one no-treatment waiting list control condition in an experimental evaluation of the procedure . Group 1 was treated individually and Group 2 was treated as a group . Almost two-thirds of the drinking partners of clients in treatment made a significant move towards change , compared with none of the drinkers in the waiting list control condition


Title 6:
Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease.
Abstract 6:
Patients ( N = 114 ) consecutively entering a medical service with ulcer , cirrhosis or pancreatitis , currently drinking and not currently active in alcoholism treatment were r and omly assigned to motivational intervention ( MI ) or to a control group . Increased utilization of alcoholism programs and self-reported sobriety at 10 weeks were assessed . MI consisted of three separate discussion s of the relationship of the patient 's disease to continued drinking and the compassionate offer of treatment . Two persons skilled in treatment also met with each MI subject and discussed treatment possibilities for them , facilitating entrance if desired . Patients in both the MI and control group were treated for their medical condition by a medical team and alcoholism treatment was always recommended . Outcome was evaluated for the period from the 10th to the 16th week after return to the community by interview of patient and household contacts and by the keeping of appointments . There were no differences between the control and MI groups , with at least 38 % remaining sober for the 10-week interval ; the study size was sufficient to detect reliably a 30 % improvement . We conclude that additional motivational intervention to this level was not beneficial to the hospitalized alcoholic with disease . There was a statistically significant increase in sobriety among patients who either undertook alcoholism therapy , accepted all parts of the study or kept clinical appointments


Title 7:
RANDOMISED TRIAL OF COMMUNITY-BASED CENTRE VERSUS CONVENTIONAL HOSPITAL MANAGEMENT IN TREATMENT OF ALCOHOLISM
Abstract 7:
151 problem drinkers ( 105 men and 46 women ) were recruited from the general medical and psychiatric services of a district general hospital and were allocated r and omly to a community-based day centre ( ACCEPT ) or st and ard hospital inpatient and outpatient services . 115 patients ( 79 % ) were followed up at 12 months . The group as a whole showed improvement in all outcome indices at the 3-month follow-up , and this was maintained at 6 and 12 months . Patients assigned to ACCEPT services cl aim ed to have reduced their alcohol intake ( 55 % ) more than their hospital counterparts ( 37 % ) , and this was confirmed by their informants . Patients referred from the psychiatric services reduced their alcohol intake more than those from general medical services . It is concluded that treatment at a community day centre is at least as cost effective as hospital treatment of alcohol abuse


Title 8:
The effect of general practitioners' advice to heavy drinking men.
Abstract 8:
The objective of the study was to determine the effectiveness of  advice from general practitioners to heavy drinking men ( consuming 350 - 1050 grams of alcohol per week ) to reduce their alcohol consumption .  One hundred and fifty-four men recruited from eight general practice s were allocated r and omly to treatment and control groups . Men in the treatment group received advice from their own general practitioner . At one year follow-up , when analyzed according to intention to treat , the treatment group had reduced their consumption by an excess of 65 grams of alcohol per week when compared with the control group ( p less than 0.05 ) . General practitioners should be recommended to screen for alcohol consumption amongst their patients and to give advice to those found to be at risk because of their drinking


Title 9:
Long-term outpatient treatment in alcoholics with previous suicidal behavior.
Abstract 9:
The importance of previous suicidal behavior for the treatment of alcoholics was analyzed in a long-term outpatient treatment study . In a series of 72 patients , 21 patients , ( 29 % ) , 17 men and 4 women , had previously made at least one suicide attempt or had seriously threatened to kill themselves ( 3 cases ) . In comparison with the other alcoholics , those with previous suicidal behavior had a similar attrition rate , they were not more troublesome in treatment , and they had the same rate of favorable outcome during the third year after start of treatment . They differed from the other alcoholics in having a more severe abuse and a less favorable outcome during the initial part of the treatment . In conclusion , our results support the possibility of a long-term outpatient treatment strategy in alcoholics with previous suicide attempts


Title 10:
Cue exposure in moderation drinking: a comparison with cognitive-behavior therapy.
Abstract 10:
To date , the published controlled trials on exposure to alcohol cues have had an abstinence treatment goal . A modification of cue exposure ( CE ) for moderation drinking , which incorporated priming doses of alcohol , could train participants to stop drinking after 2 to 3 drinks . This study examined the effects of modified CE within sessions , combined with directed homework practice .  Nondependent problem drinkers who requested a moderation drinking goal were r and omly allocated to modified CE or st and ard cognitive-behavior therapy ( CBT ) for alcohol abuse . Both interventions were delivered in 6 90-min group sessions . Eighty-one percent of eligible participants completed treatment and follow-up assessment . Over 6 months , CE produced significantly greater reductions than CBT  in participants ' reports of drinking frequency and consumption on each occasion . No pretreatment variables significantly predicted outcome . The modified CE procedure appears viable for nondependent drinkers who want to adopt a moderate drinking goal
Interventions among convicted drunk drivers reduced motor vehicle crashes and injuries .
The results suggest that treatment for problem drinking may reduce injuries and their antecedents .