It has been widely acknowledged that in order to effectively combat adolescent substance abuse problems, schools should offer a comprehensive continuum of coordinated care that offers programs ranging from primary prevention targeted to non-users to tertiary prevention targeted to students in recovery. Despite the agreement over these needs, schools have fallen into the habit of offering primary prevention programs alone that are designed to prevent the use of alcohol, tobacco, and other drugs. The current article reviews the current state of substance abuse among American adolescents before exploring the barriers that prevent schools from adopting a more comprehensive approach to adolescent substance abuse prevention and intervention. In particular, the authors focus on barriers to establishing post-identification services for students whose functioning is already impaired by substance use. Barriers range from governmental messages telling schools that post-identification services are not their job to school’s uncertainty as to how to deliver effective services to substance use impaired students. Models of school-based services are presented and recommendations are made for school-based continuum of care services, such as fighting for parity in insurance coverage to help cover costs. References