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o be engaged in treatment during the first year of follow-up. Thus, it appears that a greater number of usual care participants sought work immediately. Employment gains for the ICM group that emerged in the second year of follow-up were likely related to ICM participants completing treatment and being available to work as well as having had significantly higher rates of abstinence than those in the usual-care group. The overall pattern of employment findings is consistent with underlying assumptions of those advocating the importance of substance use disorders treatment before employment training for welfare recipients with substance use disorders.16 Specifically, on average, treatment facilitates abstinence29 and abstinence significantly increases the likelihood of later employment. Estimations of the magnitude of employment effects for the ICM group depend on the specific measure and time frame under consideration. Judging conservatively, the magnitude of the effects is quite modest if we consider the primary employment indicator (days employed) and limit interpretation to the 2-year follow-up period. In a less restrictive interpretation, the acceleration of effects at the end of the follow-up period and substantially higher rate of abstinence among ICM participants suggest that the eventual magnitude of employment effects for the ICM group at later time points may be large. Unfortunately, data are not available on later employment outcomes. In addition, during the end of follow-up, absolute rates of employment in the ICM group were low. Fewer than 1 in 3 ICM respondents reported any work in the past month, and about 1 in 5 reported full-time employment. Placed in context, rates for the comparison sample were 50% reporting any work and 34% reporting full-time work. Generalizability To the best of our knowledge, only 1 previous study examined the effects of adding case management to substance use disorders treatment for those with substance use disorders, but that study found no effects on employment. 30 One previous report on the CASAWORKS program found improved employment and substance use outcomes for drugdependent women receiving TANF.31 However, that evaluation used a single group pre-post intervention design. A number of studies have found that more substance use disorders treatment is related to better employment outcomes. 32-34 However, those studies used quasiexperimental designs and select cohorts, making interpretation of findings less certain. A number of study limitations should be noted. We generally modeled exclusion criteria on the criteria that welfare agencies use to defer clients from work . However, we excluded clients already enrolled in methadone or other substance use disorders treatment and those with less severe substance use disorders. Results should generalize well to the types of substance use disorders clients about whom TANF agencies are most concerned: those with significant substance use problems who screen positive for substance use disorders and are not engaged in treatment. Employment outcomes were based on selfreport. Most welfare studies use administrative data to report on employment. Administrative records are likely to be more reliable but do not include "off the books" or "under the table" employment. In addition, the study employed a manual-guided, well-supervised ICM approach. It is not clear whether findings would generalize to less intensive or structured case management approaches.