John Lilja on Godlaski and Clark's "Implementation issues in an innovative rural substance misuser treatment program".

This article is essentially the story of the development, implementation, and testing of a treatment protocol designed specifically for rural individuals who are substance misusers. Although the treatment protocol that emerged from this process seemed to be valuable for clients, the researchers were not able to establish with statistical significance that it was better than conventional treatment. In some ways, this was a failure. This article explores some of the possible reasons why new treatment approaches, tested in real clinical situations, may have difficulty establishing their effectiveness. The factors involved are many and complex.