The purpose of this study was to examine the cost and frequency of health services utilization by substance dependent women before and after the initiation of substance dependence treatment in a Medicaid population. The specific goal of the study was to determine whether cost and frequency of health services utilization are different before and after the subject has begun substance dependence treatment. The design was a secondary analysis of the Maryland Medicaid Claims Database created by the Maryland Center for Health Program Development and Management. The sample consisted of 114 females, the total number of female Maryland Medicaid recipients age 18 or older, who were residents of Baltimore City and were new to substance dependence treatment during the first half of fiscal year 1997 for whom complete data were available. Data were selected from the database and analyzed using paired t-tests and multiple regression to test four hypotheses related to cost and frequency of health services utilization. Both frequency and cost of health services were higher in the six month period following the initiation of substance dependence treatment than for the six month period before. These findings suggest that the severity of the consequences of substance dependence for women, as reported in the literature, was demonstrated in the Maryland Medicaid population. The findings also suggest that the initiation of substance dependence treatment may have brought about a behavioral change of renewed caring for self. Further research is needed regarding the specific services utilized and documented outcomes in order to design appropriate health care delivery systems for this population.