OBJECTIVE To investigate patterns of alcohol consumption and abuse and substance use among persons with spinal cord injury (SCI), relating these patterns to demographic and injury-related characteristics, as well as to key medical and psychosocial outcomes. METHODS Retrospective cross-sectional. METHODS Subjects with traumatic SCI (N=3041) with dates of injury between June 6, 1975, and June 23, 2002, who were interviewed between November 2000 and March 2003. METHODS Sixteen Model Spinal Cord Injury Systems participating in this collaborative study during the 2000-2005 grant cycle. METHODS Not applicable. METHODS Alcohol consumption, substance use, CAGE questionnaire, Satisfaction With Life Scale, Craig Handicap Assessment Reporting Technique, and pain. Data were analyzed using chi-square tests, analysis of variance, analysis of covariance, and logistic regression models. RESULTS Fourteen percent of the subjects were classified as likely to have an alcohol abuse issue, based on the CAGE, and 11% reported using illegal drugs or prescription medications for nonmedical reasons. Demographic and injury characteristics were associated with alcohol consumption patterns, abuse, and substance use. At-risk drinkers and substance users tended to be younger, single, male, and less educated. Those who were CAGE positive and substance users reported more pain and lower satisfaction with life. Persons who drank without indication of problem drinking had superior occupation outcomes. Pressure ulcers were associated with substance use. CONCLUSIONS Alcohol abuse and substance use were related to a number of adverse outcomes. The specific role of drinking with increased work activity deserves further exploration.