OBJECTIVE: This study examined the effects of an innovative treatment model that was designed to reduce treatment dropout among substance abusing or dependent juvenile offenders. METHOD: One hundred eighteen delinquents who met diagnostic criteria for substance abuse or dependence were randomly assigned to receive either home-based multisystemic therapy (N=58) or treatment that was provided by the usual community services (N=60). RESULTS: In the multisystemic therapy condition, 98% (N=57) of the families completed a full course of treatment, which lasted an average of 130 days. In contrast, 78% (N=47) of the families assigned to treatment through the usual community services received no mental health or substance abuse treatment in the 5 months after referral. CONCLUSIONS: The serious and long-standing problem of high dropout rates in the substance abuse field can be greatly attenuated by services that increase accessibility and place greater responsibility for engagement on service providers.