Although integrated approaches are recommended and effective for treating patients with co-occurring substance use and psychotic disorders (SUD-PSY), many patients receive standard, nonintegrated substance use disorder (SUD) treatment. Research has yet to investigate how patients with co-occurring substance use and psychotic disorders respond to standard SUD treatment, an issue we address here. In a naturalistic follow-up of 236 male SUD-PSY patients receiving 12-step facilitation or cognitive-behavioral-oriented SUD treatment, we found that patients (1) demonstrated significant improvements in proximal outcomes (e.g., approach coping) from treatment intake to discharge, and in distal outcomes (e.g., psychiatric symptoms, substance use frequency) from treatment intake to 1- and 5-year follow-ups, and (2) tended to have similar outcomes whether they received 12-step facilitation or cognitive-behavioral SUD treatment. Patients who (3) were more involved in treatment, as reflected by more positive perceptions of and more satisfaction, tended to experience better proximal outcomes and engage in more continuing care, and those who (4) experienced better proximal outcomes tended to have better psychiatric and substance use outcomes in the years following treatment. Our results suggest that SUD-PSY patients can benefit from standard SUD treatments, even though it may not directly address their psychiatric disorders.