Patients in treatment for substance-use disorders tend to smoke at higher rates than the general population. However, despite the fact such patients may be interested in smoking cessation and have been shown to be able to quit successfully without jeopardizing their sobriety, clinicians are often reluctant to advise their patients to stop smoking. The purpose of this paper is to review factors associated with the adoption of tobacco treatment interventions (TTIs) in the general population and among patients in recovery. We attempt to identify barriers to TTI use and determine where interventions should be directed. Studies were collected using various computerized databases and in consultation experts on tobacco control. We conclude that obstacles to TTI adoption involve the interaction of individual clinician, organizational, and environmental factors, and that changes in all three are needed to increase TTI adoption among substance abuse treatment clinicians. Finally, we offer suggestions regarding where future research is warranted.