Substance-specific services are tailored to address the inappropriate use of chemicals such as alcohol and marijuana. Unfortunately, few teens ever access such need-based services. This article explores the paths to substance-specific service use in a sample of urban adolescents who are public service sector users: a direct path from substance misuse and an indirect path from general mental health service use. Results indicate that even though a significant percentage of youths frequently consume substances and display negative use-related behaviors, few actually received substance-specific services. Contributors to the substance misuse path included youths' family substance dependence and environmental stressors. Contributors to the mental health services path were comorbid depression and substance misuse.