Children raised in families where one or both parents use illicit substances are at high risk for poor outcomes in many areas, such as school achievement and psychological adjustment. As such, a pilot program known as Parents Under Pressure was advertised in a methadone clinic and was designed to improve child behavior, decrease parental stress, and generally improve the functioning of families in which the parents are under methadone maintenance. The program, which is delivered in their homes, targets affect regulation, mood, views of self as a parent, drug use, and parenting skills. Nine families completed the pilot program and 8 families were followed-up after 3 months. A semi-structured interview was used to obtain demographic information, child abuse history, drug abuse history, and treatment history. Several psychological scales were used, including the Parenting Stress Index-Short Form, the Child Abuse Potential Inventory, the Significant Other Scale, and the Opiate Treatment Index. Results of the evaluation revealed family improvements in parental functioning, parent-child relationship, and parental substance use and risk behavior. The majority of families reported a decrease in concurrent alcohol use, HIV risk-taking behavior, and maintenance dose of methadone. Furthermore, families reported a high level of satisfaction with the pilot program. Future evaluations should include measures of child outcome and parental functioning. A randomized controlled trial is recommended to further evaluate the treatment program. Tables, references