A referral to treatment gets documented in fewer than 1 percent. Fewer than one in five adolescents with a substance use disorder gets any treatment. Fewer than a third get follow-up care within 60 days of an ED visit where substance use came up. The ED is often the only point of contact these teens have with the health system for this issue. They don't seek out primary care for substance use on their own, and parents don't always know what to ask a pediatrician.