Neighborhood‐level geographic factors may put individuals at risk of developing substance abuse problems. The purpose of this descriptive study was to assess the spatial distribution of risk in Buffalo, New York. The study serves as an example of how neighborhood geographical markers can be used to determine areas with elevated risk that may lead providers to better target and address substance use disorder prevalence in communities. Results showed highest risk for negative treatment outcomes in areas with either high socioeconomic or physical environmental risk; maximum total risk was largely located on the Lower West Side, West Side, and East Sides of Buffalo, while maximum socioeconomic and physical environmental risks were dispersed throughout the city. This landscape model and risk assessment delineates the distribution of risk factors associated with negative treatment outcomes and is therefore a useful tool for treatment providers who wish to better target interventions.