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Historically, research on professional psychosocial interventions focused first on development of theoretical frameworks to explain change and to direct intervention efforts. Examples of such frameworks include cognitive-behavioral, twelve-step, and motivational enhancement. Subsequent research in this area included studies to refine the internal validity of studies of these frameworks using therapy manuals, training, and monitoring; development and use of well-validated and reliable instruments; and improved research designs such as randomized controlled trials. The results were unexpected: treatments with very different conceptual frameworks and intervention techniques have approximately equivalent (and reasonably good) outcomes (e.g., abstinence or significantly decreased drinking and consequences). Furthermore, relatively brief, non-intensive treatments yield outcomes as good as more intensive treatments. These results suggest that non-specific factors such as a decision to seek help, installation of hope, empathy and the therapeutic alliance may be more important than specific factors hypothesized by treatment models.