OBJECTIVE: This study examined Electronic Health Record (EHR) utilization among US substance use disorder (SUD) versus mental health (MH) treatment facilities. METHODS: Data from the National Survey of Substance Abuse Treatment Services and the National Mental Health Services Survey were used to examine differences in clinical and administrative utilization of EHR. RESULTS: EHR use was significantly less common among SUD facilities compared to MH facilities for both non-exclusive (mixed computer and paper) and exclusive (paper-free) use. Fewer than 25 % of facilities of either type reported exclusive EHR use for core clinical activities (progress notes, laboratory monitoring, and prescriptions) with wide variability among states. Being an inpatient facility, having Joint Commission accreditation, being a private-for-profit, or a public facility were significantly positively associated with exclusive EHR use for core clinical activities; these associations were stronger among SUD facilities than MH facilities. Accepting Medicare was associated with exclusive EHR use for core clinical activities in both facility types, while accepting private insurance was associated with such use only among SUD treatment facilities. CONCLUSIONS: EHR adoption among SUD facilities lags behind MH facilities. However, exclusive EHR use for clinical purposes remains elusive for both types of facilities with no more than a quarter of facilities in any state reporting such use. Some of the factors associated with exclusive EHR use for clinical purposes among SUD treatment facilities-such as Joint Commission accreditation-may be policy leverage points to expedite EHR adoption in these facilities.