Study results indicated that primary care providers most commonly reported lack of time as the main barrier to adolescent substance abuse screening, followed by lack of training on how to manage a positive screen. While providers reported they had sufficient time to administer a short substance abuse screen, they did not have sufficient time to manage a positive result during a well care visit. Other barriers reported by primary care providers included the need to triage competing problems, lack of treatment resources, difficult parents, and unfamiliarity with screening tools. The findings suggest that a lack of time combined with poor training on how to handle positive screenings is keeping many primary care providers from screening those adolescents most in need of help. Providers clearly need training, education, and support for substance abuse screening in order to provide appropriate care for their adolescent patients. Future research should focus on developing effective methods for handling positive substance abuse screens during primary care visits. Participants were 38 primary care providers at 6 sites who completed focus group interviews about barriers to adolescent substance abuse screenings. The resulting data was transcribed and analyzed by ranking barriers across all sites by the number of groups identifying the barrier. Then the mean ranking was calculated for each barrier. Table, references