Barriers to treatment effectiveness may result from inappropriate and inaccessible services and poor coordination between adult and child services, and a thorough assessment is important for treatment planning. Various treatment settings and the effectiveness of different treatment modalities are reviewed. Goals of family treatment approaches and specific barriers to treatment are identified. The relative lack of well-controlled empirical studies focusing on treatment approaches specifically for young people with drug and alcohol abuse and comorbid psychosocial problems is discussed. The author concludes that engaging and retaining high-risk young people in treatment requires collaboration between agencies and that new treatment approaches and different service delivery models need to be researched and evaluated. 44 references and 7 tables