Limitations in using existing alcohol treatment trials to develop practice guidelines

In recent years, substantial efforts have been made to identify "best practices" and develop comprehensive practice guidelines for the treatment of various psychiatric disorders and medical conditions, based on systematic, often quantitative reviews of the existing intervention research. There probably are more than 300 comparative treatment trials that have been conducted in the alcohol field. With this large body of research, one might think the development of alcohol treatment guidelines would be a straightforward task. Unfortunately, that is not the case. Four problems are discussed with the "box-score" reviews that have been conducted thus far to identify effective alcohol treatment modalities. At least two of these problems are fundamental barriers to determining the relative efficacy or effectiveness of alcohol treatment modalities even in "meta-analyses" with "effect sizes". These impediments are discussed, as is how future alcohol treatment trials could be conducted so that their findings would more readily inform practice guidelines.