This statement addresses the challenge of evaluating and managing the various stages of substance use by children and adolescents in the context of pediatric practice. Approaches are suggested that would assist the pediatrician in differentiating highly prevalent experimental and occasional use from more severe use with adverse consequences that affect emotional, behavioral, educational, or physical health. Comorbid psychiatric conditions are common and should be evaluated and treated simultaneously by child and adolescent mental health specialists. Guidelines for referral based on severity of involvement using established patient treatment-matching criteria are outlined. Pediatricians need to become familiar with treatment professionals and facilities in their communities and to ensure that treatment for adolescent patients is appropriate based on their developmental, psychosocial, medical, and mental health needs. The family should be encouraged to participate actively in the treatment process.

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