The expansion of behavioral health services to school-based health centers under the Affordable Care Act (Public Law 111-148) presents an opportunity to improve access to substance use disorders treatment for youth and reduce their substance use, and emotional, health, and school problems. We explore the feasibility of implementing five to seven sessions of motivational enhancement therapy--cognitive behavioral therapy (MET/CBT) in school settings relative to a matched cohort in community settings. Results indicate that MET/CBT in school settings is feasible, effective, and cost-effective. Moreover, it reaches youth earlier after the onset of substance use and has the possibility to reduce existing health disparities for girls and ethnic minorities.