What is the future of manual guided therapies? It is clear that the burgeoning number of empirically validated therapies for the addictions and related disorders are not being rapidly assimilated into clinical practice, and research has only begun to address some of the critical issues regarding the translation of empirically supported therapies to clinical practice. To a large extent, efficacy studies have not addressed key translational issues such as the efficacy of empirically validated therapies with respect to standard practice or ‘clinicians choice’ models. Data are also needed regarding the kind of training is needed by what kind of clinicians to effectively implement different kinds of therapies, or whether it is cost-effective to train clinicians at all. Several alternate models of effectiveness research and strategies for bridging the gap between research and practice will be presented.