The National Youth Risk Behavior Survey (2018) reported that in North Carolina, approximately 25% of adolescents currently drink alcohol and 18% currently use marijuana. Adolescent alcohol and substance use influence academic performance, personal safety, and mental health. Many adolescents are not screened in the primary care setting (PCS) for alcohol and substance use. Methods: Standardized alcohol and substance use screening and interventions were implemented in a pediatric PCS. The interventions were motivational interviewing and referrals, based on the screening results and discretion of the providers. Descriptive statistics evaluated tool usage, adherence to interventions by the providers, population demographics, and categorized substances used. Secondary outcomes were measured by Spearman’s Correlation analysis that evaluated the association between the PHQ-9M score and CRAFFT risk. Findings: The CRAFFT screening tool version 2.1 and interventions were successfully implemented in a pediatric PCS. A very weak association was found between PHQ-9M score and CRAFFT risk. Conclusion: The quality intervention project provided a standardized process for alcohol and substance use screening. The project is sustainable due to its simplicity and EHR documentation. Keywords: substance use/abuse; adolescent; quality improvement, teen PHQ-9, CRAFFT version 2.1.