Chronic pain and substance use disorders frequently co-occur. The pharmacological treatment of pain is complicated in individuals with substance use disorders because of the potential for abuse and diversion of many prescription pain medications. One potential approach is to use a combination of cognitive-behavioral and acceptance-based strategies to manage pain and decrease substance misuse with chronic pain acceptance to help increase contact with valued life activities. After reviewing the literature on pain and substance use, this report provides an overview of a new manualized treatment for chronic pain in those with drug or alcohol misuse. Pilot data are presented as preliminary evidence for the feasibility of delivering this intervention to individuals in drug or alcohol treatment. Future directions for research on co-occurring pain and substance use are discussed. (Contains 3 tables.)