Current research indicates that D/deaf and hard of hearing clients seeking treatment for substance abuse often encounter obstacles in receiving the help they need. Many of these obstacles are the result of a lack of knowledge and experience with regard to treating D/deaf and hard of hearing people. Programs designed for hearing people that attempt to serve those with a hearing loss often do more harm than good. Even the identification of D/deaf or hard of hearing individuals with substance abuse problems is ineffective. This article reviews factors that result in disparities in substance abuse treatment for this population including approaches, accessibility and adapted materials.