Inner-city adolescents are often faced with momentous decisions regarding substance use that can drastically affect their future health and well-being. Those seeking mental health services may be at greater risk for substance use and experimentation than their non-clinical peers. Therefore, providers need to know adolescents' perceptions and understandings of their own drug use in order to effectively engage them in discussion and treatment. Based on a sample of 759 inner-city adolescents seeking mental health services at the Mount Sinai Adolescent Health Center (AHC) and their responses to Adquest, the Adolescent Intake Questionnaire, specifically the substance use section, this study analyzed the substance use data on several levels to better understand adolescents seeking mental health services, and perceptions of their own drug use. The findings indicate that urban adolescents are at serious risk for substance abuse. However, the study shows that mental health service applicants are willing to disclose their substance use behaviors and are open to talking about them to intake workers. Age and gender differences in substance use patterns and willingness to talk were explored. In conclusion, practitioners working with these adolescents must integrate their own understanding of mental health counseling to include drug prevention and treatment. References