It shouldn't surprise anyone that at a conference devoted to improving quality in addiction treatment organizations, some of the most respected leaders in the field carried the message of "change or die" to attendees. A second-day plenary session at the State Associations of Addiction Services/Network for the Improvement of Addiction Treatment conference featured more than a few ominous-sounding comments from the impressive panel. SAMHSA Administrator Terry Cline, PhD, told the audience, "I don't believe there ever will be enough resources to close that [treatment] gap if we keep providing services the way we are." He proceeded to discuss the importance of experimenting with process improvements (SAMHSA is doing that in its own operations) and partnering with primary care as physicians begin to engage in screening and brief intervention for patients' substance use problems. David H. Gustafson, PhD, the Network's director, pointed out an unfortunate statistical distinction between addiction treatment and other health disciplines: 73% of addiction service costs are labor costs. "I don't think it's sustainable, folks," he said of that level. And A. Thomas McLellan, PhD, chairman and CEO of the Treatment Research Institute, who has delivered many recent talks on how the specialty treatment field needs to broaden its focus beyond the most seriously ill clients, also called for more integration with "mainstream" health care. One of his comments about the specialty field's responsibility to treat the sickest of the sick hit particularly hard. "Addiction treatment programs are the new housing projects," he declared.