Certain recruitment problems related to the refusal of women to participate in a clinical trial, while other problems concerned the nature of the disease of drug dependence. Still other problems stemmed from the reluctance of social service and health care providers to refer clients for treatment. Recruitment strategies incorporated a philosophy of patient recovery and recruitment scripts that featured motivational interviewing techniques. Using results from focus groups of women in treatment, it was determined that reluctance to enter treatment had more to do with denial of drug dependence than with concerns about research or randomization. Problems associated with participation in a clinical trial appeared to involve community clinician attitudes and not opinions of pregnant women being recruited. Five recruitment-specific activities were initiated over the course of the project: (1) a recruitment committee was formed to review recruitment activities and progress; (2) recruitment protocols were enhanced to incorporate existing knowledge about treatment techniques and limit the amount of time case managers spent on recruiting individual women; (3) a recruitment coordinator was hired to survey social service and health care providers; (4) project staff were encouraged to become involved in recruitment efforts; and (5) project staff encouraged representatives of potential referral sources to visit the treatment facility. The use of public health nurses and social workers as primary recruiters proved to be effective in getting women into treatment. Maternity case managers incorporated their expertise in working with difficult populations and their knowledge of community resources into a specialized advocacy role, working with women toward the primary goal of referral to drug treatment. Over the length of the project, more than 1,000 women were recruited and 366 were enrolled in the project. Most women recruited to the project were either in the first or second trimester of pregnancy. Two case management vignettes are included that describe typical legal, social, and medical support advocacy efforts for drug-abusing pregnant women. 9 references and 4 figures