Adolescents that enter substance abuse treatment programs are more likely than peers that do not abuse drugs to have oppositional behavior, aggressiveness, impulsivity, and poor frustration tolerance. They are also more likely to have experienced abuse or neglect and significant family problems. They are more likely to have developed a psychiatric disorder during early childhood, such as learning disability, attention deficit/hyperactivity, or oppositional defiant disorder. By the time an adolescent enters substance treatment, he or she often has reaped the cumulative psychological, health, and social consequences of earlier developmental adversities and behavior problems. Research-based treatment modalities for adolescent SUD include pharmacotherapy, and behavioral or psychosocial interventions that include family-based interventions, cognitive-behavioral therapy, and community reinforcement therapy. Controlled efficacy trials, along with the results of systematic treatment program evaluation, clearly indicate that treatment for adolescent SUD is effective in reducing drug use and improving associated behavioral, familial, and psychosocial outcomes. These outcomes are enhanced when a combination of modalities is offered in a comprehensive, integrated treatment plan that addresses drug abuse and a broad range of biopsychosocial problems, skill deficits, and psychiatric problems. Although integrating the treatment of psychiatric comorbidity with substance abuse treatment has lagged behind integration of other treatment services, recent advances in the state of the science can now better inform practice guidelines. This integrated treatment model may serve as a helpful guide for clinicians until further research can contribute to its refinement. 40 references