This paper reviews the literature on ambulatory substance abuse treatment for adolescents, including brief intervention, Twelve-Step-based outpatient treatment, family-based treatment, cognitive behavioral therapy, and pharmacologic treatment. An overview of socially and culturally specific strategies is also included. The diversity of settings and approaches and combinations of approaches in the treatment of adolescents is emphasized as are adaptations of Twelve-Step and other group based interventions. Family-based and multisystem therapy, adapted for substance using adolescents, is highlighted as a promising future direction of effective treatment.