The purpose of this study was to compare a relatively new therapeutic option for substance abuse treatment, Health Realization, and 12-Step approaches offered in women's residential programs. The study was sponsored by a large California county's Department of Alcohol and Drug Services, which had offered Health Realization treatment for a number of years. This study constitutes the first systematic evaluation of Health Realization as a substance abuse treatment program for adult women in a residential treatment setting. This was a randomized study with two observations-admission and 9 months post-admission. The results showed that clients in both Health Realization and 12-Step treatment exhibited comparable outcomes on domains such as substance use, criminal justice involvement, employment, housing, adverse effects of substance use and psychological well being. Substance use declined significantly between admission and follow-up in both treatment groups, irrespective of duration of treatment. Similarly, adverse effects of substance use declined between admission and 9-month follow-up. Health Realization and 12-Step treatment offered comparable benefits for women in residential substance abuse treatment programs.