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In Reply: Dr Stringer and colleagues raise concerns about generalizability of the results of the study by Johnson et al to clinical populations. This study was an efficacy trial and as such required stringent inclusion and exclusion criteria, which limit external validity. Effectiveness trials in community settings and with broad inclusion are indeed needed, but such studies are expensive, lengthy, and difficult, limiting the number of questions that can be addressed in this way.

Study participants in many pharmacotherapy trials are recruited through newspaper advertisements rather than treatment centers. Although such participants may be "less ill than average" compared with patients in treatment programs, they may still be ill and suffering. Furthermore, they are more representative of the large majority of alcohol-dependent people in the community, most of whom are not accessing currently available treatments but are seen frequently in primary care, trauma care, and mental health care settings.^1-2 It . . . [Full Text of this Article]

Mark L. Willenbring, MD
mlw@niaaa.hih.gov
National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
Bethesda, Maryland

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