The purpose of this study was to examine pregnant women's substance use from initial use, to recognition of problem severity, motivations for treatment, and ultimately to treatment entry. The sample consisted of 114 pregnant women receiving inpatient detoxification treatment at the University of Kentucky Chandler Medical Center. Qualitative and quantitative measures, collected via face to face interviews, were used to examine participants' demographics, substance use history, problem severity, perceptions/satisfaction with treatment, treatment motivation, and long-term treatment plans. The following themes emerged from the qualitative data analysis. Substance use typically began as experimentation. Most viewed their substance use as severe and were happy to be in treatment. Sobriety was the main long-term treatment goal. Current pregnancy was the top treatment motivator. Majority reported some type of formal, post-treatment discharge plan. Future research should explore problem severity. Identifying factors that influence substance-using women to actually recognize the severity of their problem may shed light on treatment entry behaviors.