Substance use disorders (SUD) are an important health problem and certain patients with SUD find themselves frequently returning to hospital services (1,2). In order to improve access to care, assertive outreach treatment models such as community treatment have been implemented over the last few decades. However, service use remains high for a number of patients with SUD. Different risk factors associated with high service use can be determined. In order to reduce service use, it is important to identify at-risk patients and their needs, which will allow to better adapt community treatment models. A cohort study (3) examining predictors related to the frequency of emergency department (ED) use among 4,731 patients with substance-related disorders found that high ED users presented more complex and severe conditions and mainly visited ED repeatedly for subacute or non-urgent problems. High ED users were more likely men. They more often had a socioeconomic disadvantage, but also some middle income. Another cohort study (4) analyzing 970 admissions of patients with SUD on factors associated with the length of hospital stay, found that higher Health of Nation Outcome Scales admission scores and number of previous hospitalizations predicted longer stays. This implies that these patients presented higher symptom levels and more psychosocial problems on admission. A study (5) on unplanned readmissions among patients with SUD, showed that longer first hospitalizations reduced the risk of unplanned readmission. A systematic review on assertive community treatment (6) found this model overall beneficial for patients with SUD in particular in increasing treatment engagement. Advance statements were found to be feasible and acceptable tools for patients with SUD to reduce treatment disengagement (7). Overall, the studies show that risk factors for high service use among patients with SUD are the presence of more severe and complex disorders, including co-occurring mental disorders/SUD or physical illness, more psychosocial problems and a history of acute service use. They also indicate the benefits of community treatment and advance statements. In the light of these findings, community-based treatments for SUD and co-occurring disorders, addressing social problems, as well as treatment continuity are necessary to improve access to care and reduce high service use. Future research needs to focus on the impact of community treatment models and how to adapt programs to patients at risk of treatment disengagement and also on the development of new recovery-oriented approaches for patients with SUD.