This paper examines advocacy and policy components of the Conrad N. Hilton Foundation’s (the Foundation) Youth Substance Use Prevention and Early Intervention Strategic Initiative (the Initiative). The Initiative’s grantees addressed local, state, and federal policies to support long-term implementation of adolescent screening, brief intervention, and referral to treatment (SBIRT) and other substance use disorder (SUD) prevention and cannabis policy strategies.

Several key advocacy and policy lessons emerged from the Foundation’s first six years of grant making. They include advocating to:

• Expand addiction medicine training to equip the workforce to address prevention of unhealthy substance use and SUDs in primary care settings.
• Increase SUD prevention services in Medicaid.
• Enforce the Mental Health Parity and Addiction Equity Act and Affordable Care Act’s SUD treatment coverage.
• Adopt recovery supports in communities to sustain long-term recovery from SUDs.
• Secure financing streams for supporting youth SBIRT.
• Increase access to SBIRT in schools and community settings.

Common elements of successful strategies include:

• Building coalitions to strengthen impact in local communities.
• Elevating youth voices and experiences in policy and advocacy initiatives.
• Tracking policy activity at the state and local level to understand policy issues and priorities and facilitate relationship building with policymakers.
• Providing resources and training to support and guide advocates.