Substance and alcohol abuse problems are major causes of mortality and morbidity, and these problems often begin in adolescence. Adolescent years are a key window of vulnerability to substance use disorders because the brain is still developing and malleable (characterized by neuroplasticity). The brain systems governing emotion and reward seeking are the first to develop during childhood whereas the circuits governing judgment and self-inhibition, i.e. prefrontal cortex, are not matured until early adulthood, causing teenagers to tend to act on impulse, seek new sensations, and be easily influenced by their peers for risky behaviors. All substance use puts adolescents not only at risk of short-term problems, such as accidents, fights, unwise or unwanted sexual activity, and overdose, but also vulnerable to the effects of substance use and developing long-term consequences, such as mental health disorders, underachievement in school, a substance use disorder, and cognitive deficits.
　　Destigmatization, early identification using a valid screening tool, prompt referral and interventions is critical for the managing the growing problems in current society. Pediatric primary care professionals are ideally placed to identify drug absue problems in their adolescent patients and intervene before the problems become more serious. Unfortunately, the implementation of screening, brief intervention, and referral to treatment (SBIRT) for adolescents remains in paucity in pediatric health systems despite a mature body of evidence demonstrating the effectiveness of SBIRT in adolescents. We believe all services or programs should be seen as part of a continuum of care and the path to recovery, and multidisciplinary approach is quintessential for the management.