The purpose of this study was to assess the rate of self-reported substance use, consequent problems, perceived need for treatment, and receipt of treatment by persons with long-term spinal cord injury (SCI). Information was obtained from 86 persons with traumatic SCI who were between 13 and 58 years of age at injury, cognitively intact, injured more than two years earlier, English speaking, and recruited from two SCI organizations. The mean age of the sample was 39.5 years at recruitment: 69% were men. Participants reported substance use information across four periods covering six months before injury to an average of 13 years after injury. All participants reported use of substances with abuse potential at some time in their lives; the time of greatest use was injury to six months before first interview. The duration of this period ranged from 18 months to 43 years. Problems resulting from substance use were reported by 70%; more than half (52%) the sample reported problems during this postinjury period. Sixteen percent of the sample believed they needed treatment at some time; the time of greatest perceived need was in the period after injury. Treatment for substance abuse was received by 7%. Problems attributable to abuse of both prescription and nonprescription medication were reported, suggesting the importance of close monitoring of substance-use patterns in persons with SCI who are prescribed sedating or narcotic medications. Timely assessment of problems related to substance use and provision of treatment services to persons with traumatic injury are indicated to prevent a potential dual disability.