Private alcohol problem treatment in the United States arose from a social movement that began after Prohibition and culminated in the founding of the National Institute on Alcohol Abuse and Alcoholism in 1970. Using a treatment model that incorporated much of the ideology of Alcoholics Anonymous, an isomorphic set of private treatment centers grew rapidly across the country with support and assistance from NIAAA. As this support diminished and cost containment emerged, a crisis struck the population of treatment centers, leading to many closures. Nonetheless, most of the centers have survived. This chapter uses data from a national longitudinal study of privately funded alcohol problem treatment centers to illustrate the transformation of the treatment industry during the 1990s. We argue that this transformation results from an increased difficulty in obtaining treatment funding due to the health care cost-containment practices of managed care.