A 1999 study by the Center on Addiction and Substance Abuse at Columbia University reported that substance abuse causes or worsens 7 out of 10 cases of child abuse or neglect, with children whose parents misuse alcohol or drugs being 3 times more likely than other children to be abused. Two options are available for children who live in homes where substance abuse is a major issue. The first is to remove the child from the home for the purpose of permanent placement or adoption, and the second option for intervention is to develop a system of resources that could assist the family in addressing the substance abuse and developing the skills necessary to provide protection and care for the children. The latter option requires a comprehensive system of resources, a coordinated effort by numerous social and welfare systems, and a treatment strategy that will address all the issues that affect both the adults and children in the family. Current efforts at developing such a system are either fragmented or absent. This chapter outlines the steps for family preservation and support services prepared by the U.S. Department of Health and Human Services in 1994. The chapter concludes with guidelines for assessment and treatment of parents and families in which both substance abuse and child abuse are involved. A relevant case study with follow-up questions is provided. 5 selected readings