We studied the effects of limestone sand additions in Bear and Rock runs, two chronically and episodically acidified streams in southwestern Pennsylvania, U.S.A. Linn Run, a nearby episodically acidified stream, served as a reference stream. Our objectives were to evaluate the effects of doubling recommended limestone sand amounts on water quality and macroinvertebrates on Bear and Rock runs and to assess substrate changes resulting from limestone sand inundation. Approximately 23 and 6 tonnes of limestone sand were added annually to the headwaters of Bear and Rock runs, respectively, from 1999 to 2001. In 2002, amounts were doubled. Macroinvertebrate communities were assessed from 1999 to 2003 at points above and below the sand additions on Bear Run and Rock Run. Small, plastic substrate samplers were used to assess sand substrate effects. Doubling annual limestone sand amounts resulted in significantly improved pH and acidneutralizing capacity; however, total dissolved aluminum increased significantly downstream (a • 0.05). Macroinvertebrate density and diversity were not significantly affected, but an increase in acid-sensitive taxa was observed at a site 3,500 m downstream. Substrate sampler data indicated a significant negative relationship between amount of sand deposited and density of macroinvertebrates. The mixed water quality and benthic macroinvertebrate results were reasonably consistent with earlier work and call into question the use of limestone sand in the restoration of chronically and episodically acidified waters.