The substance abuse treatment literature has overlooked the needs of sexual minority clients in general, but particularly sexual minority women, a category including lesbians, bisexual women, and women with same-sex experiences or attractions who do not use the aforementioned labels. Sexual minority women have rates of substance use disorders that exceed rates of heterosexual women, are as likely or more likely to seek help, and are likely to have treatment issues that differ from sexual minority men and heterosexual women. This review of the literature focuses treatment availability, access, and identifying elements of culturally-sensitive treatment for sexual minority women, with a special focus on minority stress. Some potential best practices for sexual minority women include trauma-informed treatment systems, lesbian, gay, bisexual, transgender–responsive agencies, welcoming and inclusive climate, and linkages with sexual minority women's community resources and social networks.