Abstract
Treatment decisions about complex patients with both substance use disorders and chronic mental illness cannot be reduced to an inpatient vs. outpatient dichotomy. Treatment progresses through a series of stages, in each of which we must make decisions about treatment settings and approaches. I discuss treatment decisions within the framework of a staged treatment model, reviewing decisions to be made during stabilization, engagement, persuasion, active (or primary) treatment, and relapse prevention (or aftercare).