Sensitivity analysis indicates that from both perspectives the service is very cost effective and may be cost saving .
CONCLUSIONS These results make alcohol screening and counseling one of the highest-ranking preventive services among the 25 effective services evaluated using st and ardized methods .
BACKGROUND The U.S. Preventive Services Task Force ( USPSTF ) has recommended screening and behavioral counseling interventions in primary care to reduce alcohol misuse .
This study was design ed to develop a st and ardized rating for the clinical ly preventable burden and cost effectiveness of complying with that recommendation that would allow comparisons across many recommended services .
Examining mechanisms of action in 12-Step community outpatient treatment.
Twelve-step theory hypothesizes that changes in specific cognitions and behaviors , including adoption of disease model beliefs and involvement in self-help programs , lead to symptom reduction . We examined the role of self-help affiliation in treatment outcome using causal chain analysis . Baseline , end-treatment and follow-up self-help affiliation  and substance use were assessed in 252 drug and alcohol abusers attending a community program . Participants were r and omly assigned to one of three cognitive-behavioral or 12-Step oriented individual counseling conditions . Participants also were assigned , based on problem severity , to one of three treatment setting s ( partial hospitalization ; intensive outpatient ; st and ard outpatient ) that varied according to intensity of additional 12-Step programming . Repeated- measures ANOVA indicated that self-help affiliation increased overall during treatment , particularly in the 12-Step counseling condition ( versus cognitive-behavioral ) , and the partial hospitalization setting ( versus st and ard outpatient ) . Multiple regression indicated that self-help affiliation was negatively associated with substance use 6 months post-treatment , and that this was not moderated by condition . Self-help affiliation predicted outcome most strongly in the partial hospitalization setting and not at all in outpatient ; however , this effect was accounted for by participants ' initial problem severity : high-severity patients had poorer outcomes if they failed to increase self-help affiliation , relative to those who increased affiliation and to low-severity patients regardless of affiliation . Results indicate that , in this community-based program , self-help affiliation increased as a function of exposure to 12-Step oriented treatment programming , and significantly predicted better outcome among patients with high levels of problem severity . Implication s for future treatment process and dissemination research are discussed
Sensitivity analysis indicates that from both perspectives the service is very cost effective and may be cost saving .
CONCLUSIONS These results make alcohol screening and counseling one of the highest-ranking preventive services among the 25 effective services evaluated using st and ardized methods .
BACKGROUND The U.S. Preventive Services Task Force ( USPSTF ) has recommended screening and behavioral counseling interventions in primary care to reduce alcohol misuse .
This study was design ed to develop a st and ardized rating for the clinical ly preventable burden and cost effectiveness of complying with that recommendation that would allow comparisons across many recommended services .