From Doorway to Lifeline: Reimagining the Emergency Department’s Role in Adolescent Substance Use Care

Adolescents with substance use disorders (SUDs) frequently present to emergency departments (EDs), yet the care they receive often ends at screening, brief counseling, or discharge instructions that do little to alter long-term outcomes. Although the ED serves as a critical point of contact, it is often portrayed as a passive waypoint rather than an active driver of treatment initiation and sustained engagement. This presentation argues that improving outcomes for adolescents with SUD requires a fundamental reimagining of the ED, not as a standalone site of identification, but as an integrated community intervention hub. The presentation will examine why many ED-based approaches to adolescent SUD care underperform, focusing on three recurrent challenges: misalignment with ED workflow, limited authentic partnership with community stakeholders, and an overreliance on screening metrics as indicators of success. It will challenge the assumption that identification alone is sufficient, highlighting how screening without accessible and trusted treatment pathways can reinforce disengagement and exacerbate inequities, particularly among historically marginalized populations. The core of the presentation will describe a pragmatic, community-engaged model for adolescent SUD care designed around real-world ED constraints. Key elements include: (1) program development grounded in co-design with community organizations, families, and youth; (2) patient flow models that integrate substance use assessment and treatment initiation without disrupting emergency care delivery; and (3) structured outreach beyond ED discharge that establishes bidirectional relationships between emergency departments and community-based services. This approach moves beyond traditional ED-based screening and referral models by positioning the emergency department as an active, bidirectional partner in community substance use treatment rather than a point of episodic intervention. Rather than presenting an idealized or resource-intensive framework, the session will emphasize adaptable principles that can be implemented across diverse clinical environments. Throughout the presentation, emphasis will be placed on shifting evaluation from process measures, such as screening rates, to outcomes that matter to patients and communities, including timely linkage to care, continuity of engagement, and trust in the healthcare system. Common implementation barriers, including staffing limitations, time pressure, and clinician discomfort, will be addressed, along with practical strategies to navigate these challenges. The concepts presented are relevant to emergency medicine clinicians, program leaders, and educators seeking to design sustainable and equitable substance use care pathways within the constraints of real-world emergency practice. Attendees will leave with a clear framework for reframing adolescent SUD care in the emergency department and concrete strategies to strengthen community-connected treatment pathways that meaningfully improve patient outcomes.