Dear Editor, Substance use and dependence remains a very serious health problem in developed countries. Therefore, evaluating and monitoring the efficacy of substance use treatment programmes has become a matter of growing concern. The use of brief and multi-dimensional instruments has been indicated as a possible solution 1,2 , since it allows a swift diagnosis of the individual and the services one was provided with, enabling the adjustment of the interventions according to the users' needs and comorbidities [3][4][5][6][7][8][9] . In order to evaluate and monitoring the efficacy of substance use treatments, a pilot study was undertaken for the Portuguese population based on a brief multi-dimensional instrument, the Texas Christian University -Client Evaluation of Self and Treatment -TCU -CEST 1 . The choice of this instrument was based upon four basic criteria: (a) adequate values of validity and fidelity found in the original instrument 1 , (b) applicability to a variety of dependence treatment programmes, (c) wide evaluation of the efficacy indicators diversity, and (d) confirmed utility in the clinical practice 1,10 . The instrument is composed of a total of 130 items that are grouped into four dimensions: (a) motivation for treatment, (b) psychological functioning, (c) social functioning, and (d) therapeutic process 1,4,10 . At first, the translation and back--translation were done by a bilingual specialist. This was followed by the spoken reflection with 30 users aimed at evaluating the items' understanding and adequacy and individual pilot interviews with 8 professionals of 4 specialties (2 social work assistants, 3 psychologists, 2 psychiatrists and 1 nurse). As a second step, the questionnaire was administered to a convenience sample of 120 users (75% in a programme of opioid replacement therapy with methadone), in 028-.083, α = .329-.655); and, in terms of internal consistency, the subscales Self-efficacy (α = .542), Risky behaviour (α = .665) and Social conscience (α = .406). The small size of the sample and its specificity (75% in a programme of opioid replacement therapy with methadone) may have contributed to the reported results. As so, given the inadequacy of some items of the dimension Motivation for the treatment, we have suggested the elimination of this dimension in future applications of the TCU-CEST -Portuguese version 2 . The results of this study also underscore the need to revising the subscales Self-efficacy, Risky behaviour and Social conscience, as to achieve a closer cultural adaptation to the Portuguese context. Finally, further research should be undertaken in order to assess the validity of the instrument TCU-CEST, by examining its adequacy with samples of users dependent on other drugs and users in different treatment programmes.

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Background: Practitioners need brief instruments to monitor outcomes in both treatment of drugs and alcohol addiction because they are useful to guide decision making in a short time. Objectives: This study aims to develop a brief questionnaire, based on Client Evaluation of Self and Treatment, to evaluate the treatment effectiveness in drug and alcohol addiction treatment settings. Methods: A cross-sectional study using a convenience sample (N = 608) recruited from Division for Intervention on Addictive Behaviours and Dependencies (DICAD -ARS North). Results: The results show a new four-factor solution that accounted for 54.4% of the total variance and that provides the best fit to the data (c 2 /df = 1.72, CFI = .94, GFI = .91, RMSEA = .048 [.040-.057]; prmsea = .623). It also revealed a high internal consistency (a = .82). It was found a significant negative correlation (r = -.52, p < .01) between the final version of the instrument and a self report measure of psychopathology symptoms. Discussion: This brief questionnaire, with good psychometric properties, can be useful to provide a viable and rapid feedback of treatment outcomes. Further studies should be performed to continue the evaluation of the reliability of this measure.

Background: In Portugal, as far as we know, there are no recent studies that evaluated the comparative efficacy of therapeutic modalities in addiction problems by reference to a holistic and psychosocial model of effectiveness. Objectives: Using a sample of Portuguese patients in outpatient treatment for drug and alcohol abuse, this study aimed to examine if a combined treatment modality (group therapy with individual intervention) had greater overall efficacy when compared to other three types of treatment without group therapy. Methods: This is a correlational and cross-sectional study using a convenience sample of patients (N = 254) from an outpatient treatment in the Intervention Service on Addictive Behaviors and Substance Dependence. At the time of data collection, the patients were attending four types of treatment, such as receiving intervention based on individual psychological counseling (n = 66); receiving individual psychiatric counseling (n = 68); receiving both individual psychological and psychiatric counseling (n = 102); and receiving not only individual counseling (i.e., psychology or psychiatry), but also attending group therapy (n = 18). Results: Using MANOVA and Wilks's multivariate test criterion, there was a significant effect of treatment modality on the global efficacy, Λ = 0.88, F(9, 603) = 3.75, p < 0.0001. Examination of mean estimates indicated that patients in a combined therapeutic modality revealed more treatment involvement compared to patients in other therapeutic modalities without group therapy. Discussion: The results obtained in this study highlight the importance of integrating interventions in a collaborative way. A combined therapeutic modality, adding group therapy, was associated with positive effects, such as more levels of peer support and involvement in treatment, and increasing the individual's probability to remain abstinent.

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