The landscape related to adolescent substance use has changed significantly in the 21st century. The drugs used by teens today are different than the drugs used in the last century and the age of first-time substance use is steadily decreasing. Prevention and intervention approaches related to substance use have progressed and are successfully supporting adults through the challenges of addiction, but adolescents oftentimes don't get the support or services needed for healing and recovery. Developmental changes occurring in adolescent brains and bodies can magnify feelings of fear and frustration for teens. Communication, harm reduction strategies and stigma awareness are designed to empower and provide practical tools by which individuals supporting teens can become involved in substance use prevention and intervention. As the landscape changes so must our approaches to prevention and intervention related to adolescent substance use. Communication, harm reduction and anti-stigma strategies can empower adolescents and adults to work together to change attitudes and behaviors related to adolescent drug use.