Most vocational rehabilitation systems have insisted that applicants who have co-occurring substance use disorders be clean and sober for six months before entering a vocational rehabilitation program. Some evidence exists, however, indicating vocational rehabilitation delivered simultaneously with addiction recovery services may lead to better outcomes. The author examines evidence within the State-Federal Vocational Rehabilitation System in the United States and makes observations and recommendations for improving services delivered to individuals with physical and sensory disabilities who also have co-occurring substance use disorders.