In summary, it is apparent that discussions on substance abuse should begin at the prenatal visit and extend through adolescence. Educational efforts and preventive strategies must be given highest priority. Signs and symptoms may be subtle, and pediatricians should have a high index of suspicion, particularly for high-risk individuals. Practitioners also must be willing to routinely address other important psychosocial-medical issues that are closely correlated with the use of drugs and alcohol. Laboratory assessment and formal substance abuse screening instruments should be used under selected circumstances. Following diagnosis, referral to the appropriate resources and coordination of follow-up services are important roles for the primary care clinician.