The author argues that five main factors have affected substance abuse treatment in the United States: the war on drugs, managed health care, advancements in research and treatment technologies, faith-based groups offering substance abuse services, and the involvement of social workers in the treatment of substance abuse. These issues are discussed in separate sections throughout the article. The current war on drugs currently enjoys $20 billion in Federal funds and emphasizes law enforcement and interdiction solutions. Drug treatment, while stated as a goal of the war on drugs, is only allocated about one-third of the budget, with the clear emphasis of the Federal program being on law enforcement functions and punishment. Managed health care has similarly compromised substance abuse treatment because it limits access to treatment. The author claims that despite these set-backs in the treatment of substance abuse, research concerning effective treatments continues to abound and more effort is being put into translating research into actual treatment practice. The article also discusses the Bush administration’s controversial initiative of funding faith- and religious-based organizations that deliver substance abuse treatment. It remains to be seen how such an initiative will change the face of substance abuse treatment in the United States. Finally, the article explores the way in which social workers interact with clients, especially clients with substance abuse problems. Although social workers see many such clients, only a fraction of the social workers have the credentials to treat substance abuse. Issues facing this group include the problem of inexperienced social workers offering substance abuse treatment and the problem of whether low-paid social workers can afford to be properly credentialed in a world in which credentials come with reoccurring fees. In conclusion, the author states that it is important to keep an eye on how these counteracting influences will shape substance abuse treatment in the coming years. References