Limitations in using existing alcohol treatment trials to develop practice guidelines

Abstract

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.

Examining Treatment Use Among Alcohol-Dependent Individuals From a Population Perspective

“…Reviews of treatment efficacy assume that problem drinkers receive one treatment type (limitation identified in, Finney, 2000;Miller and Wilbourne, 2002). In contrast, health services descriptions of treatment use sometimes describe alcohol problems as chronic conditions for which the drinker returns to treatment repeatedly (e.g.…”

Motivational interviewing: Is it all our clients need?

“…The reviewing method used by Burke and colleagues was based on the ''box score'' method developed by Miller et al (1995) and this has been criticized by Finney (2000). Whether or not these criticisms are justified, the earlier review by Burke et al was superseded by a later work by Burke et al (2003) who used quantitative meta-analysis in a technically sophisticated manner.…”

Alcohol Problems

“…Instead, it is necessary to rely on the 'box-score' method in which individual studies are rated for the degree to which they either support or do not support a specific modality and an aggregate effectiveness score is arrived at by summing these ratings. This method of data synthesis has been criticised (for example, by Finney, 2000) but it is probably the best source of information available at present.…”