Adolescent alcohol and drug use disorders pose significant risks to adolescents' future functioning. Unfortunately, relapse rates following treatment for these disorders are high. The newest generation of interventions, designed in part to address this problem, place greater focus on the developmental needs of adolescents. In this review, we highlight the importance and promise of this progress in the field. We also argue for a further, more complete, integration of development and treatment: Instead of a focus on developmental issues as part of the process of substance use treatment, we argue for an approach in which healthy development is an outcome of equal importance to changes in substance use and risk behaviors. From this perspective, treatment should address the skills necessary for social, emotional, achievement, and identity development, with substance abuse understood as one example of dysfunctional development. We argue that this approach holds the greatest promise for providing adolescents in treatment with the skills they need to maintain successful post-treatment trajectories. In this paper, we offer theory underlying this perspective, a definition of the outcomes of healthy development that can guide researchers and clinicians, as well as proposals for both researchers and clinicians to continue to push the developmental sensitivity of adolescent substance use treatment forward.