A self-report questionnaire was administered anonymously to all 6th, 8th, 10th, and 12th grade students (N=27,995) enrolled in public and private schools throughout Hawaii. The executive summary presents the key findings from this study. Section 1 presents lifetime prevalence and trend data, which indicates that the lifetime use of any illicit drug increased steadily in 1993 and 1996 and finally decreased among all age levels in 2000. Marijuana was the most prevalent drug, with 2002 lifetime marijuana prevalence holding steady for all grades except 10th grade, where marijuana prevalence increased by 3 percent. Lifetime prevalence and trend data are offered for 11 classes of drugs: marijuana, inhalants, cocaine, methamphetamine, heroin or other opiates, sedatives or tranquilizers, hallucinogens, steroids, “club drugs,” alcohol, and tobacco. Section 2 offers monthly and daily prevalence and trend data, which indicate that the monthly use of any illicit drug increased sharply for all grades in 1996 and then began to decrease by 2000. Section 3 offers a summary of adolescent treatment needs, which was based on the DSM-III-R criteria for the treatment needs of adolescents. Estimates indicate that 1 percent of 6th graders, 6 percent of 8th graders, 16 percent of 10th graders, and 21 percent of 12th graders in Hawaii need substance abuse treatment. Approximately half the adolescents who need treatment require help for both alcohol and drug abuse. Treatment needs center mainly on marijuana abuse. Less than 15 percent of the participants who were determined to need substance abuse treatment have utilized treatment facilities in the past. Section 4 presents the observed adolescent prevention needs in Hawaii. In determining prevention needs, substance use onset, attitudes and beliefs about drugs, and the social environment were analyzed. A comprehensive risk and protective framework is described. Section 5 offers concluding remarks and recommendations. Adolescent substance abuse continues to be a significant problem for Hawaii, although stable drug patterns and declining treatment needs are encouraging indicators that the problem may be declining. The author recommends that the role of the family be strengthened in substance abuse prevention efforts and that mass media coverage on substance abuse prevention and treatment be increased. Figures, tables, appendix, references