In December 1993, a national meeting of judges, prosecutors, defense lawyers, bar association representatives, court administrators, substance abuse treatment providers, and representatives of other service agencies who are engaged in a specialized treatment approach to processing drug-involved offenders was held to discuss issues in the operation of treatment drug courts. This report identifies the key elements of treatment drug courts as they have been established in a variety of locations across the United States. Discussions at the conference addressed many issues including: judicial leadership and the judicial role in treatment drug courts; collaboration between and among the various criminal justice agencies, courts, treatment agencies, and community organizations in establishing drug court and its treatment approach; education and training programs; defining the target population of the treatment drug court; funding sources; producing a detailed implementation plan to describe how the court will operate, including scheduling milestones and orientation and training for all of the participants; and an evaluation strategy designed to identify the information required to measure outcome measures of interest. Also included are discussions of the treatment drug court versus traditional case processing and referral to treatment; establishing a framework of collaboration and cooperation between criminal justice and treatment agencies and the community; the judicial role in the drug court treatment approach; the roles of defense and prosecution counsel; the role of acupuncture; and the implications of drug courts for managing criminal courts. Actions involving the treatment drug court approach taken since the conference are summarized. Conference recommendations are enumerated including the need to establish a resource center and clearinghouse to facilitate justice and treatment innovation in collaborative court approaches.