OBJECTIVE The authors describe outcomes of a targeted case and care management program for persons with addictions utilizing a high level of acute services in Connecticut's system of care. METHODS Administrative and cost data were analyzed from five consecutive years (2004-2008) (N=165,305 clients). RESULTS In the year after enrollment, acute care episodes fell by 56% compared with the year before enrollment, with a 19% increase in engagement in nonacute care services. Paid units of acute care fell by 62%; paid units of nonacute care increased by 63%. Costs of care were approximately 46% lower in the year after enrollment. CONCLUSIONS Findings suggest that outcomes can be improved while costs and acute care demands can be reduced through combined use of care management to identify high users and case management to engage them in lower levels of care. The system was able to reallocate acute care resources to nonacute services and serve additional clients.