<qa>  What is the primary care setting that provides a unique opportunity to intervene with substance abusingOver the past decade, many new programs intended to motivate adolescents to decrease substance use have been developed and evaluated. There has been a recent shift towards brief interventions for youth in school Brown, 2001; DAmico and Fromme, 2002 and health care settings, such as emergency rooms and inpatient clinics Barnett et al., 2001; Colby et al., 1998; Monti et al., 1999. Many youth who use drugs and alcohol are at risk for consequences Johnston et al., 2003. The primary care setting presents a unique opportunity to intervene with substance abusing adolescents as 70 of youth age 10-18 visit a physician approximately 3 times a year Gans and Newacheck, 1991; Monheit and Cunningham, 1992. However, many youth are not screened for use in this setting Friedman et al., 1990; Johnson and Millstein, 2003; Middleman et al., 1995 and preventive services are significantly below recommended levels Halpern-Felsher et al., 2000; Klein et al., 2001; Ozer et al., 2001. This may be due to clinician time constraints and insufficient training on substance abuse, adolescent fear that parents may see the record, and clinician discomfort in asking questions about substance use Blum, 1987; Blum et al., 1996; Lustig et al., 2001; Marcell et al., 2002; Middleman et al., 1995. 