Although trends in substance use disorder (SUD) prevalence and treatment receipt have been relatively constant for the last decade, the Affordable Care Act (ACA) could result in a substantial increase in the number of individuals seeking or referred to treatment. The impact of parity legislation, changing perspectives about the importance of SUDs as a health condition, the opioid epidemic, and activities associated with care integration could result in additional increases in demand. In contrast the SUD treatment workforce is already challenged to meet the existing demand for treatment. A significant number of facilities reported operating at or above capacity. Low wages make hiring and retaining qualified staff a challenge. A review of the services provided to clients indicated that current practice was often inconsistent with the scientific findings on evidence-based treatment. Credentialing experts and clinical directors expressed concern about training adequacy, and the best available information suggests, at most, a small increase in training program output in recent years. Thus, overall, the SUD treatment workforce appears to lack sufficient capacity to adequately address the possible short-run increases in demand.