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This study examined outcomes for 97 clients diagnosed with mental illness and substance abuse (MISA) during 18 months of treatment. Clients were assigned to an experimental or control group at each of three community mental health centers (CMHCs). Two different experimental treatment approaches were used: assertive community treatment (ACT) and reference groups (RG). Controls received usual CMHC services. Substance abuse involved primarily alcohol; at study admission the sample members were assessed to be similar in their severity of alcohol abuse to a sample of persons hospitalized for chronic alcohol use. After 18 months, 65% of ACT clients and 83% of RG, compared to 40% of controls, were still engaged in treatment. Few differences were found between the experimental groups and controls in client outcomes. RG clients reported a reduction in alcohol and marijuana use during the treatment period. During follow-us ACT and controls reduced hospital days compared to the prior year, whereas RG and controls decreased number of hospital admissions.