Researchers say nearly half of in Northern Marianas' public high school students are regular underage drinkers.
The Commonwealth Health Centre in the Northern Marianas is coordinating a study on substance abuse in the US Pacific territory, using data from the Health Department, police, youth services and schools.
The centre's James Arriola has told Radio Australia's Pacific Beat program young people are often not allowed to drink alcohol for legal and cultural reasons.
"So when they do get alcohol, often times they don't sit around and drink it slowly and responsibly, they binge drink," he said.
Mr Arriola says the centre is trying to tackle substance abuse not just among teenagers but across the population.
He says prevention methods used on the US mainland don't work so well in a Pacific setting, so the centre has devised its own, island-focused approach.
"What we're trying to do is create a more holistic system of care that works to bridge the gaps between our traditional systems of understanding prevention and our new national institutions that serve as the primary system of education," he said.
Mr Arriola said substance abuse, including alcohol and tobacco use, is having a devastating impact on the health of people living in the region.
"One of the biggest problems in the region, not just in the Mariana Islands but throughout Micronesia, is we have a huge epidemic of non-communicable diseases going on," he said.
"A huge part of that is primarily related to substance abuse and misuse."