Of the 2.4 million juvenile arrests made in 2000, 78.4 percent (1.9 million) involved children and teens who were under the influence of alcohol or drugs while committing their crime, had a drug or drugs in their system at the time of arrest, were involved in a drug-related crime, or reported having substance abuse problems. Compared with juveniles who have not been arrested, juveniles arrested once in the past year were much more likely to have used a variety of drugs. Substance abuse among juvenile offenders occurs in combination with the following delinquency-related factors: adverse family conditions, residence in poor and dangerous neighborhoods, school maladjustment, health problems, risky sexual behavior, negative peer influence, and a lack of religious influence. Although comprehensive prevention approaches offer hope, few program models exist. A comprehensive model would include features that strengthen families, increase school engagement, reinforce positive peer groups, strengthen neighborhood resources, reduce poverty, and offer spiritual guidance. After substance abuse develops, there are many points in case processing where juveniles can be diagnosed and treated. Juvenile drug courts provide referral to intensive treatment and monitoring to ensure compliance with treatment regimens. Treatment must be combined with accountability. Data used in this article were derived from a study conducted by Columbia University's National Center on Addiction and Substance Abuse (CASA), which analyzed multiple government and private databases. The data was for the year 2000. 4 tables and 39 references