Despite the decrease in Tuberculosis (TB) in Chicago over the past ten years, substance users remain at an increased risk for TB and failing TB treatment. The goals of this study are to investigate the effectiveness of using former substance users (enhanced arm) vs. Chicago Department of Pubic Health (CDPH) workers (standard arm) in performing Directly Observed Therapy and TB contact tracing for substance users with TB. The study compares the two arms in terms of (1) TB treatment completion and treatment compliance, (2) TB contact tracing, and (3) lifestyle changes among adult substance users with TB in Chicago. This study was a randomized trial, in which participants were extensively interviewed at baseline and 6-9 month follow-up. Contact tracing was also performed on the participants' contacts. Forty-six participants were randomized to standard arm and 48 to enhanced arm. Participants in the standard arm had a 2.7 greater risk for failing to complete treatment, 39% vs. 15%, (95% CI 1.24-5.82). Likewise, they had a higher risk of not being compliant while on treatment (RR=2.5, 95% CI 1.15-5.48) and of missing a DOT appointment (OR=2.91, 95% CI 1.46-5.81). Seventy-five percent of cases in the enhanced arm identified contacts, compared to only 47% in the standard arm (p=0.003). Otherwise, the success of contact tracing in the two arms was not significantly different for following proper screening procedures or identifying high risk contacts. In comparing the two treatment arms there were no significant differences for lifestyle changes. However when looking at the study population as a whole, participants were significantly more likely to report that they were not using drugs at follow-up as compared to baseline (p<0.0001), and not using substances with people they did not know. Participants also had a decrease in the number of sexual partners (p=0.017) and increased condom usage (p=.031). Participants also reported decreased stigmatization (p=0.0008). This study demonstrates that using former substance users to deliver DOT to current substance users with TB gives higher rates of completing treatment and complying with the treatment regimen. For contact tracing, former substance users were only more successful in getting cases to name their contacts. Lastly, this study demonstrates that having TB and receiving DOT causes a reduction in risk behaviors and decreased stigma.