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ABSTRACT: The increase in cocaine use among pregnant women has created significant challenges for treatment providers. Drug-dependent women tend to neglect general health and prenatal care. Perinatal management is often difficult due to medical, obstetrical, and psychiatric complications. Research has demonstrated that comprehensive care, including high risk obstetrical care, psychosocial services, and addiction treatment can reduce complications associated with perinatal substance abuse. Research investigating the effectiveness of residential and outpatient treatment for pregnant cocaine-dependent women also suggests that many biopsychosocial characteristics and issues influence treatment outcomes. Homelessness and psychiatric illness require a more intensive level of care, and abstinence is difficult to maintain for many women in outpatient treatment as they continue to live in drug-using environments. To optimize the benefit of comprehensive services, services should be provided within a multilevel model of substance abuse treatment including long- and short-term residential, intensive outpatient, and outpatient settings.