The American Academy of Pediatric Dentistry (AAPD) recognizes that substance misuse in adolescents is a significant health, social, and familial issue in the United States. The increasing prevalence of substance misuse among adolescents obligates dental personnel to identify behaviors characteristic of active use, recognize clinical signs and symptoms of active use or withdrawal, modify dental treatment accordingly, and facilitate referral to medical providers or behavioral addiction specialists. This policy addresses the harmful effects of alcohol and drug misuse in the adolescent and the dental provider’s role in recognition, initiation of appropriate interventions, and referrals.