This qualitative study explores strategies used by mental health providers (N = 17) to address substance use problems among seriously mentally ill (SMI) clients and their perspectives on barriers to treatment and how treatment can be improved. Providers identified numerous strategies, yet these were countered with perceptions of multiple obstacles, leaving them frustrated, helpless, and hopeless about their clients' substance use. Results suggest that, in addition to improving access to quality dual-diagnosis treatment, larger issues of poverty and social isolation must also be addressed. Not doing so limits what providers can do for SMI clients and could reduce the effect of larger system-level improvements.