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Objective: Test hypotheses that proximity to new transit improves substance use disorder treatment provider cost efficiency (i.e., economies of scale and scope). Data Sources and Study Setting: Connecticut substance uses disorder treatment providers/programs. A 2015 rapid transit line opening with 10 stations, near some providers/programs. Providers' annual operating costs from publicly available federal tax forms (2013-2018). Annual client counts, service-type (including substance use disorder and/or mental health, among others), and location data, for 50 providers and their programs, from Department of Mental Health and Addiction Services, with an unbalanced panel of 285 provider-years. Study Design: Economies of scale occur when the percent change in operating costs is less than the percentage change in clients. Economies of scope occur when operating costs fall as providers treat clients with multiple service needs. With our quasiexperimental, multivariate regressions approach, we test hypotheses that proximity to a new transit line enhances economies of scale and scope (i.e., lowers unit operating costs). Data Collection/Extraction Methods: Annual provider-level operating costs merged with new transit station locations and Department of Mental Health and Addiction Services program/provider-level secondary data (locations, client counts/completions/dates, service types, and average demographics). Principal Findings: For providers with programs within 1-mile of new transit (compared with a 'control' sample beyond 1-mile of new transit), (i) a 10% increase in clients leads to a 0.12% lower operating costs per client; (ii) a 10% increase in clients completing treatment results in a 1.5% decrease in operating costs per client; (iii) a 10% increase in clients receiving treatment for multiple services causes a 0.81% lower operating costs per client; (iv) offering multiple services leads to 6.3% lower operating costs. Conclusions: New transit proximity causes operating cost savings for substance use disorder/mental health treatment providers. System alignment may benefit transit and health care sectors. KEYWORDS health care costs, integrated delivery systems, social determinants of health, substance abuse: Alcohol/chemical dependency /tobacco What is known on this topic * Substance use disorder treatment in the US is costly and with scarce resources, not everyone in need can receive treatment. * Transportation is often a barrier to substance use disorder treatment that can also lead to missed/late appointments and idle clinician time, increasing provider operating costs. * Sometimes, budgetary constraints may imply higher operating costs could lead to a need to cut back on clients served. Prior research has not adequately addressed this potential reverse causality. What this study adds * A quasi-experimental approach develops causal estimates of the impact of proximity to new transit on provider operating costs. * There are statistically significant lower per-client operating costs as client counts rise (i.e., enhanced economies of scale) for providers with some programs near the new transit, compared with providers farther from the new transit lines. * Similarly, proximity to a new transit line leads to lower operating costs (i.e., improved economies of scope) for providers offering multiple (e.g., substance use disorder and mental health) services. * System alignment between transit and substance use disorder/mental health treatment can be beneficial by leading to lower provider operating costs., 1 | INTRODUCTION Illicit substance use and prescription misuse cost our economy more than $600 billion each year. (1) With roughly 2.7 million people, 12+ years of age receiving treatment [...]