Problem drinkers (N = 49) and individuals presenting with both alcohol and cocaine problems (N = 51) admitted to a traditional 28-day alcoholism treatment milieu were compared on their psychosocial, psychological, neuropsychological functioning and substance abuse at admission as well as at six months posttreatment follow-up. On admission, alcohol and cocaine patients were younger, more likely to live alone or with their family of origin, to report having started using alcohol at an earlier age, to have fewer alcohol-related problems and to have fewer years of but more diversity in their substance abuse than the alcohol-only patients. Otherwise both groups were more similar than different on psychosocial, psychological and neuropsychological dimensions. At six-months posttreatment, both groups showed similar improvement on most dimensions of functioning measured. However, a significantly greater proportion of the alcohol and cocaine abusers admitted to having relapsed in the previous six months, reported significantly fewer average days of abstinence than the alcohol group since terminating treatment, and were more likely to present urine specimens indicative of recent substance abuse at the six-month follow-up interview. Thus, traditional approaches to alcoholism treatment may be less effective in establishing abstinence for individuals with both alcohol and cocaine problems. Adaptations to treatment to reduce the risk for relapse faced by alcohol and cocaine abusers in such milieu are discussed.