Consensually established principles of clinical conduct, known various
ly as practice guidelines, standards, protocols, or algorithms, have p
roliferated throughout medicine over the past decade. Institutional an
d disciplinary efforts to develop and promulgate guidelines for the tr
eatment of addictive disorders have recently been initiated. We review
guideline development activities of the American Psychiatric Associat
ion, American Psychological Association, American Society of Addiction
Medicine, American Nurses Association, National Association of Social
Workers, and Center for Substance Abuse Treatment of the Substance Ab
use and Mental Health Services Administration. Medical care performanc
e and outcome assessments are discussed with attention to the role the
y can play in evaluating and refining guidelines. Potential effects of
guidelines, salutary and deleterious, on clinical practice in the add
ictions are delineated.