Case management has been identified as an important addition to tradit
ional services offered in drug and alcohol treatment. Implementation o
f case-management services requires a new array of managerial behavior
s by middle managers. The Missouri Department of Mental Health, Divisi
on of Alcohol and Drug Abuse, introduced case management as a central
component of the innovative Comprehensive Substance Treatment and Reha
bilitation Program. The authors, drawing from the experience in Missou
ri, describe the challenge of effectively implementing case management
in existing programs.