To determine if frequent needle-exchange program (NEP) use is associated with lower readiness to change drug use, NEP clients in Providence, RI, were interviewed regarding their drug use, HIV risk, health, and past use of drug treatment services in 1997-1998. Readiness to change drug use was assessed using a nine-step decision ladder. Based on this assessment, 14.3% of the sample were classified as precontemplators (24/168), 29.2% were in the contemplation stage (49/168), and 56.5% were in the determined or ready to change stage (95/168). The authors found that mean number of NEP visits was 25.2 among precontemplators, 28.7 among contemplators, and 22.5 among those in the determination stage. In multivariate analysis, an inverse relationship between having ever been in alcohol treatment and higher readiness to change drug use was the only significant association. In this exploratory study, the authors found that more-frequent NEP participation did not affect readiness to change drug use among intravenous drug users. Given the high proportion of NEP clients ready to change drug use, improved linkages between NEPs and substance abuse treatment appear warranted.