Substance abuse patterns were reviewed for a group of patients admitted to the Gambling Treatment Program at the Brecksville Veterans Administration Medical Center. A retrospective chart review of 113 consecutively admitted patients between September 2000 and September 2001 found that 66.4% of pathological gamblers had a lifetime history of substance abuse or dependence at some point in their lives. A history of substance abuse or dependence was less common among gamblers aged 60 and above. In the year prior to admission, 58.1% of those with a history of substance abuse or dependence were actively using substances. Alcohol was the most commonly used substance, followed by marijuana and cocaine. In most gamblers with comorbid disorders, the onset of substance dependence preceded the onset of problem gambling. Pathological gamblers engaged in multiple impulsive and dysfunctional behaviors including suicide attempts, compulsive shopping and spending, and compulsive sexual behavior, and the presence of comorbid substance abuse disorders may influence the degree to which pathological gamblers engage in these additional problematic behaviors. These factors have important implications for treatment and prevention of relapse, as well as for theories of addictions.