Abstract Numerous factors will affect the course of alcohol-drug services over the next decade, including technological-scientific advances, legislation, professional training standards, case law, availability and cost of substances, and social policy toward users. Despite some apparent lessening of substance use, high levels of substance abuse are likely to continue due to fetal damage in high-risk offspring, younger onset of substance abuse, and solo-parent families. Care givers must be prepared to treat more youth, elderly, women, minority, and "dual disorder" patients. Federal and local statecraft against substance production and use remains crude and does not show signs of the increasing sophistication observed elsewhere in the world. Although these forces favor continued high levels of substance abuse problems, the funding mechanisms to provide care are under increasing assault by both the private and public sectors. Areas in which professional practice are apt to improve include clinical assessment-reassessment, treatment outcome research, monitoring during recovery, and outpatient treatment. Professional groups and treatment organizations will become more proactive in the financial support and management of treatment services.