Substance use disorders are frequently comorbid with mood, anxiety, and psychotic disorders, and they commonly present in tandem in both primary care and psychiatric settings. Unfortunately, in the past, individuals with co-occurring substance use and mental health disorders would receive treatment in community mental health clinics only after their substance use disorder was “stabilized.” There has been increasing recognition that integrated treatment is necessary for these individuals to fully succeed and achieve recovery. This chapter uses a common presentation to illustrate up-to-date screening and treatment recommendations. Motivational interviewing, contingency management, cognitive–behavioral therapy, and medication-assisted treatment are explored. A discussion of the continuum of community-based services and systems challenges follows.