The Center has a cooperative agreement with the State of Kentucky and the Center for Substance Abuse Treatment to participate in an interstate substance abuse treatment outcome study. The purpose of the interstate study is to establish a minimum number of data items necessary for treatment outcome measurement as well as to explore questions specific to each of the nineteen states involved. The specific purpose of this project for Kentucky is to examine approaches that can be used to increase the validity and reliability of Kentucky Treatment Outcome System (KTOS) follow-up information in a rural state, and to assess the impact of treatment on outcome measures at six months post-treatment. Four sub-studies will be used to achieve this purpose. The first sub-study examines the utility of enhancing feedback to rural substance abuse clinicians in order to improve the quality, quantity, and timeliness of the established KTOS data submissions. Sub-study one provides three increasing levels of clinically relevant feedback to clinicians responsible for data collection to determine the effect of increased levels of feedback on quality, quantity, and timeliness of submitted data. The second sub-study implements and examines the feasibility of establishing a seamless local data collection approach in rural substance abuse treatment centers for baseline, tracking, and follow-up data in order to provide reliable and valid data as well as more acceptable rates of follow-up contact. This study examines differences in data collection experiences among three rural regions using case study methods. The third sub-study examines the effect of client incentives and quarterly contacts on the rates of successful client follow-up data collection. The fourth sub-study examines the impact of pre-treatment and treatment variables on changes in alcohol and drug use, psychological symptoms, violence, and economic and social circumstances at six months post-treatment. The studies are inter-related in that they each focus on increasing the quality of outcome data, but focus on different actors-study one focuses on the counselor as data collector, study two focuses on a regional data collector, and study three focuses on the client as data provider. The data generated by these studies are also used to examine the impact of treatment on treatment outcomes.