There is increasing worldwide recognition of the social and economic burden of psychotic illness. Substance use disorders frequently complicate the treatment of psychosis and are associated with increased readmission rates, decreased compliance, and increased violence and suicide risk. The Northern Territory of Australia has a scattered remote population – 25% of whom are Indigenous people. There are increasing rates of drug use across the Territory, and hospital admission rates have been gradually increasing. Psychotic disorders are the most frequent cause of hospital admissions, and substance abuse complicates the majority of these admissions. It is imperative that comprehensive treatment programs are established, integrating services, and utilising culturally appropriate cost-effective strategies.