Background The problem addressed in this Doctor of Nursing Practice (DNP) Capstone quality improvement project was the lack of substance use screening by primary care providers for adolescents ages 12-17 in Massachusetts with a validated screening tool. The Centers for Disease Control and Prevention (CDC) reports that among high school-aged students, 15 percent have reported trying an illicit drug. Opioid misuse is reported in 14 percent of high school students. Purpose The purpose of this project was to implement a process for primary care providers to screen for substance use using the CRAFFT tool at wellness visits for patients ages 12-17 seen at a family medicine office in Western Massachusetts. Methods The goal was to screen 100% of adolescents at physicals between the ages of 12-17 years old using the CRAFFT tool, and as appropriate, provide an intervention. The outcomes were measured by a chart review post-implementation of the screening tool. A decision support tool with talking points was included with the screener as well as a referral resource list for clinician decision support. Results Twelve providers screened 53 of 76 patients (69.74%) with the CRAFFT at the annual visit. Post-implementation chart review found five charts documented risk of positive substance use, or 6.57 % of patients. Pre-implementation there were no documented cases of a validated tool used for screening, only the self-report teen questionnaires were utilized. In the pre-implementation chart review, two of 79 patient charts (2.54%) documented a risk of positive substance use. Conclusion The implementation was successful in screening 69.74% of adolescents and identifying five patients for intervention at risk for substance use. Challenges with staffing turnover likely affected the distribution of the screener as well as time limitations in visits.