Utilizing an expanded concept of level of burden, the impact of multiple problems experienced by women in a residential drug abuse treatment program on treatment retention and outcomes is investigated. Level of burden is defined in this study as the number and severity of problems, including psychological problems, cognitive impairment, chronic health problems, HIV/AIDS status, as well as substance abuse. In the first study of 260 women, the ability to retain women in treatment as a function of their level of burden is examined using the technique of survival analysis. Results indicate that early in the course of treatment, high-burden clients tend to be the highest risks for early termination. In addition, there is a significant interaction between time in the program and level of burden. In the second study of 68 women, partial correlations between level of burden and ratings of outcomes by program staff at time of discharge are examined. Results show that many of the treatment outcomes are significantly negatively correlated with the initial levels of burden. Implications for treatment providers and directives for future studies are discussed.