Site visits were conducted in 1992 in Virginia, Oklahoma, Kentucky, and Puerto Rico. In addition, a survey was conducted in 1993 using a mail questionnaire to develop a regional picture of substance abuse treatment programs. Across all sites, the drug most commonly used by women was nicotine; 82 percent of women smoked cigarettes. Women had been using alcohol and other drugs most of their adult lives, for an average of 12.7 years. Alcohol and drug use usually began in the teenage years. Lives of women were filled with stress and difficulties caused by factors other than addiction, such as poverty and sole responsibility for children. Most substance abuse treatment programs said they admitted pregnant women; 63 percent of women were able to receive some form of treatment or services. About 25 percent of pregnant women were not able to gain access to treatment. Barriers to substance abuse treatment for pregnant women and women with children included fear children would be taken away from them, shame about being an alcoholic or a drug addict, depression, and denial of an addiction problem. Logistical barriers were also prevalent, such as lack of money, transportation, and child care. Other barriers concerned program admission policies, capacity, services, staffing, and medical liability. Women were also hampered in obtaining treatment by lack of information about addiction and treatment and lack of support from partners. Factors influencing entry into treatment for pregnant and parenting women included legal pressure, concern about their health and life, feelings about and relationships with children and families, and the availability of services to remove logistical barriers. Recommendations to improve substance abuse treatment for pregnant and parenting women are offered. An appendix contains data on infant mortality rates and low birthweight rates in the southern region of the United States between 1985 and 1991.