There is a dearth of substance abuse treatment programs available to pregnant substance-using women. However, even when specialized substance abuse treatment programs are offered to these high-risk women, some women will choose not to enter treatment. To gain a better understanding concerning the characteristics of pregnant substance-using women related to their decisions regarding treatment utilization, this study compares two groups of substance users: 93 pregnant women who accepted offered substance-related treatment services, and 89 pregnant women who declined the same services. All women were interviewed and information was gathered concerning their sociodemographic characteristics, their types and levels of substance use, substance use by their family members, and their experiences of being victims of violence. Bivariate analyses found that, compared to women who declined treatment, women who accepted treatment were more likely to be African-American, to be single (never married), and to have a significantly greater number of children. Bivariate analyses also showed that, compared to women who declined treatment, women who accepted treatment had more severe substance abuse problems and were more likely to have previously undergone treatment for a substance problem. Women who accepted treatment were twice as likely to have partners who used alcohol and were three times more likely to have experienced physical and/or sexual violence during pregnancy. When logistic regression procedures were used to simultaneously examine the relative impact of all of the variables on treatment utilization, the four strongest independent predictors positively associated with treatment utilization were the women's race (being African-American), the women's use of illegal drugs during pregnancy, the women's past treatment for substance abuse, and the women's use of cigarettes before pregnancy.