This study explored the training needs of substance use disorder (SUD) treatment practitioners in relation to their readiness in treating queer clients. We conducted a series of semi-structured interviews (N = 7) based in the Western Cape of South Africa. A thematic analysis identified themes related to treatment structures developed for a binary perception of gender, the burden of discrimination borne by queer clients that may impede treatment, and practitioner interest in further training and development. Our findings suggest that SUD treatment practitioners do not feel fully prepared to treat queer clients and are aware of a need for gender-sensitive training in this area. Improvements to practitioner training and readiness could yield benefits for both clients and practitioners within the treatment space.