Limitations in using existing alcohol treatment trials to develop practiceguidelines

In recent years, substantial efforts have been made to identify "best pract ices" and develop comprehensive practice guidelines for the treatment of va rious psychiatric disorders and medical conditions, based on systematic, of ten quantitative reviews of the existing intervention research. There proba bly are more than 300 comparative treatment trials that have been conducted in the alcohol field. With this large body of research, one might think th e development of alcohol treatment guidelines would be a straightforward ta sk. Unfortunately, that is not the case. Four problems are discussed with t he "box-score" reviews that have been conducted thus far to identify effect ive alcohol treatment modalities. At least two of these problems are fundam ental barriers to determining the relative efficacy or effectiveness of alc ohol treatment modalities even in "meta-analyses" with "effect sizes". Thes e impediments are discussed, as is how future alcohol treatment trials coul d be conducted so that their findings would more readily inform practice gu idelines.