Adolescence is a critical stage in human development in which individuals gain independence from parents. This vulnerable period of life often involves experimentation with intoxicating substances and other risky behaviors. This combination of factors may lead to traumatic injury that requires emergency department treatment and hospitalization. This scenario presents an opportunity for screening, education and treatment regarding substance abuse. Policies that support such measures have been shown to be poorly followed. The aim of this manuscript is to identify and discuss some of the barriers to implementation of an alcohol and drug screening policy for adolescent trauma patients admitted for inpatient hospital care.