Despite advances in preventing treatment failure, a large percentage of substance-using individuals drop out of treatment. Current work indicates that one's threshold for tolerating psychological distress (i.e., distress tolerance) is a key factor in treatment dropout. Following from this work, we developed a treatment for prevention of treatment drop-out in a residential treatment setting. Specifically 66 individuals who were a) receiving residential substance use treatment and b) evidenced deficits in distress tolerance at a baseline assessment were assigned to receive either the novel treatment (Skills for Improving Distress Intolerance, SIDI), supportive counseling (SC) treatment, or no-treatment control (NTC). We hypothesized that compared to individuals in the SC and NTC, individuals in the SIDI would show greater improvements in levels of distress tolerance, greater improvement on measures theoretically related to distress tolerance (i.e., levels of negative affect, disengagement coping, emotion regulation, self-efficacy in high-risk situations, and self-efficacy of mood regulation), and higher rates of treatment completion. Results indicated that those in SIDI evidenced greater improvement in distress tolerance, compared to SC and NTC. However, there were no significant differences in improvement in the secondary measures, except for affect regulation self-efficacy (approaching significance). It should be noted, however, that the percentage of individuals reaching clinically significant improvement showed that more individuals in SIDI, compared to SC and NTC, reached such improvement. Comparison of 30-day treatment completion showed that there were no dropouts in either SIDI or SC; all dropouts occurred in NTC. When considering dropout throughout the entire residential treatment contract (ranging from 30 to 180 days), the least dropouts occurred in SIDI, followed by SC and NTC (in this order); however, this difference was not significant. The current results suggest that SIDI is effective in increasing distress tolerance in inner-city drug users. Additionally, the variable rates of dropout that were, nevertheless, nonsiginficant suggest a need for larger-scale studies to test the effect of SIDI on dropout.