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The prevalence of unhealthy substance use (USU) among medical inpatients can vary, and prior research has not characterized the prevalence of USU among patients cared for by a teaching service (TS) and a nonteaching hospitalist service (NTHS). The objective of this study was to compare the prevalence of USU among patients cared for by a TS and an NTHS. We conducted a cross-sectional study from February to June 2009 at a community teaching hospital. Within 24 hours of admission, all eligible internal medicine admissions to the TS or NTHS were screened for USU, using the Alcohol Use Disorders Identification Test-Consumption and Drug Abuse Screening Test. Patients screening positive then underwent a diagnostic interview and blinded chart review to increase case finding and to assess whether each patient's admission was related to USU. There were 414 eligible and consenting patients out of 656 patients identified. Patients on the TS were younger and more likely to be current smokers, male, unmarried, non-white, and unemployed (p < .01 for all comparisons). TS patients were more likely to have evidence of USU (29.2% vs. 12.3%; p < .01). Among all admissions to the TS, 22.2% were deemed to be probably or possibly due to USU, as compared with only 3.7% of admissions to the NTHS (p < .01). Medical TSs care for a greater share of patients with USU as compared with an NTHS. These data highlight the need for expanded medical resident training in the diagnosis and management of USU. (Am J Addict 2012;00:1-9)