Adolescents presenting with substance use is increasingly commonplace. Fortunately, GPs are equally well placed to manage substance use with early intervention offering the greatest opportunity for positive behaviour change into adulthood. Effective approaches to prevention and intervention should be strengths-based with concurrent aims of increasing knowledge and motivation, reducing risk of further harm and building resilience. Engaging the adolescent is crucial and success depends on tailoring brief interventions that are evidence-based, age appropriate and where possible, involve the family and community.