Language is our primary tool for communication and a salient component of acculturation status among Hispanic populations. Importantly, language is associated with behavioral health outcomes and can identify and confront health disparities among Hispanic adolescents. The purpose of this study was to evaluate the association between adolescent language identity and drug use and depressive symptoms and examine parent-adolescent communication and parent language identity as mediators and moderators, respectively, of this association. We conducted a secondary data analysis (N = 746) of a study evaluating the effectiveness of a family-based intervention to prevent drug use and condomless sex among Hispanic adolescents. We evaluated whether adolescent language identity (i.e., Spanish or English) predicted (1) past 90-day drug use and (2) symptoms of anxiety and depression 30-months post-baseline and whether this relationship was mediated by parent-adolescent communication. We also examined whether the mediational pathway was moderated by parent language identity. English language identity was positively associated with past 90-day drug use and this association was mediated by parent-adolescent communication. The mediational pathway was not moderated by parent language identity. There was not a statistically significant association between English language use and anxiety/depression. However, this association was mediated by parent-adolescent communication. The mediational pathway was not moderated by parent language identity. Hispanic adolescents with an English language identity may have a greater propensity for drug use. Results emphasize the importance of promoting biculturalism and considering parent and adolescent language and communication when developing culturally syntonic interventions for Hispanic adolescents.