This study examines the meaning of motivation among young people in outpatient care for substance use problems. Semi structured interviews with 21 youth aged 15-21 years were conducted and analysed using qualitative content analysis. The results show that young people’s motivations for contacting a clinic and addressing their drug use problems can be intrinsic, extrinsic, or a combination of both. Most young people in the study expressed ambivalence about changing their drug use. Several of them described an internalisation process in which, while the impetus may initially come from others, such as parents and friends, they gradually express a personal desire to change. An important implication is that young people’s motivation can be enhanced via trusting relationships with therapists. The study concludes that motivation is complex phenomena in which young people with substance use problems oscillate between being motivated and unmotivated or find themselves in more than one position, sometimes simultaneously, in a socially mediated process.