The author advocates that a clinician play the role of a primary care therapist (PCT) for substance abusers to assure that appropriate treatment interventions are provided to meet patient needs. In treating substance abusers, the PCT must be concerned about patients' needs for control, containment, contact, and comfort, especially initially, but also in an ongoing way. The PCT functions in direct, coordinating, and monitoring roles in order to optimally provide and combine psychotherapeutic and self-help elements.