 This cluster-RCT randomly assign 201 treatment agencies in 5 states to four experimental arms. The agencies were randomized to an intervention for 18 months with a 9 month sustainability period. The study aimed to: 1 Determine whether a state-based strategy can with NIATx support can lead mainstream treatment agencies to implement and sustain process changes that improve the studys primary outcomes: time to treatment, annual clinic admissions, and continuation in treatment; and 2 Evaluate the effectiveness and cost of the services making up NIATx. This study aims to create a practical model for improving efficiency and effectiveness of addiction treatment. 