Importance: Despite decreasing substance use by adolescents in recent years, overdose rates continue to rise. Morbidity and mortality from substance use is preventable if detected; however, screening practices among youth-serving clinicians are unknown.

Question: What are the current practices surrounding substance use disorder screening, brief intervention, and referral to treatment practices among youth-serving clinicians in the US?

Findings: In this cross-sectional study of 1047 youth-serving clinicians from multiple primary care specialties in the US, 57% reported that they routinely screen adolescents for substance use disorders at every well visit. Only 39% reported using a screening tool at every well visit.

Meaning: These findings suggest that substance use disorder screening in youths needs improvement to better adhere to recommended screening practices.