Social work educators must prioritize effective preparation of MSW students for the pivotal roles they will play in supporting clients struggling with Substance Use Disorders (SUDs). Understanding what concerns MSW students have about working in the substance use field can highlight student training needs and inform learner-centered curricula. This qualitative study explored anticipated concerns held by MSW students in the mental health and addiction focus area of a Midwest university. Thirty-four MSW students beginning their final year of training answered an open-ended survey question regarding their concerns about addressing substance use in their future careers. Findings indicated that students were largely concerned about having sufficient competence, knowledge, and skills to effectively assist clients, particularly considering client self-determination. Students recognized the emotional demands of the work, especially for those who have had personal substance use experiences, and the need for self-care. Students were also concerned about demands specific to these clients and systemic barriers in the substance use field. Recommendations are presented for preparing students to manage these challenges.