Since many treated substance abusers are unable or unwilling to totally and permanently abstain from all substances after being treated, and since some treated substance abusers are able to drink and/or take drugs without abusing them, both total and permanent abstinence and controlled use should be discussed as potentially viable treatment outcomes while substance abusers are in treatment. The complexities of controlled use are articulated to the increasing problem of multiple substance abuse. Guidelines are suggested for determining who, what substance(s), under what conditions controlled use could be attempted, and how to evaluate the psychobiosocial consequences of this treatment outcome.