Adolescent substance use and its consequent sequelae is a significant public health issue that has immediate and long-term consequences. Implementation of office-based strategies such as screening for substance use and early intervention can potentially lower the rates of misuse in youth and arrest the development of abuse/ dependence. Beginning with a standardized biopsychosocial assessment, providers can obtain necessary information, such as risk and protective factors as well as substance use, to aid the development of tailored treatment plans that consist of evidenced-based psychosocial (and when applicable, pharmacological) treatment approaches to assist youth in achieving abstinence and improved global functioning. This article presents an overview of adolescent substance use and abuse including, recent trends in drug use, associated risk and protective factors, and a brief review of current treatment interventions and practices.