Among adolescents, substance abuse often occurs in conjunction with risk-taking behaviors. This review explores the nature and etiology of concomitant risk-taking behaviors, addressing behavioral, genetic, temperamental, and family factors that accompany adolescent substance use. A literature review was conducted to determine the breadth of factors that contribute to adolescent substance abuse and correlated risk-taking behaviors, and to identify relevant evidence-based treatments. The literature review revealed that among adolescents, substance abuse occurs as part of a cluster of problems and risk-taking behaviors. Predisposing factors include temperament, genetics, neurobehavioral disinhibition, social competencies, parenting, abuse/neglect, and peer behaviors. Various interventions, including individual therapies, parent training, and family therapies comprise the empirically-supported treatments for these co-occurring behaviors. The literature indicates that adolescents are being seen for substance- related problems which should be evaluated for engagement in other risk-taking behaviors, and school, peer, and social functioning. In addition, the data support that family, versus individual, interventions should be the norm for substance-abusing adolescents.