It is necessary to consider substance user treatment and derived health disparities in terms of: historical perspectives, stereotyping and "homogenization"; mystification; institutionalized disinformation; institutional myopia; institutionally created and maintained paradoxes; organizational, systemic, and human failure; the status of facts; environmental considerations; conceptual masking and overloading; fictions and fantasies; policy models and policy perversion; resource ignorance; slogans; de facto realities; the phenomenon of "lifeless lucidity" when statistical significance is not matched by substantive significance, problem definitions, and current unresolved critical issues that merit attention. The article's central thesis is that substance user treatment failure and derived health disparities are built into this complex, chaotic, nonlinear, multidimensional, highly politicalized, arbitrary, but institutionalized and "ghettoized" field that is also faulted by human, systemic, and organizational errors and that is removed from the "normed," mainstream of intervention and innovation.