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Substance abuse results in health problems by contributing to impairment and injuries. Few studies have examined how post-spinal cord injury medical complications may be affected by substance use. This study examined the use of alcohol and other drugs and the relationship between use and two medical complications, pressure ulcers and urinary tract infections. A sample of 103 persons undergoing inpatient rehabilitation was recruited and 71 followed for 30 months. An increased risk of pressure ulcers 30 months after injury was associated with use of psychotropic medications and abstinence from alcohol with a history of drinking problems; urinary tract infections were related to illicit substance use. In general, impairment characteristics were important predictors initially after injury while abstinence with a history of drinking problems predicted pressure ulcers later. Pre-injury problem drinking had enduring consequences when people abstained. Psychologists can help abstaining problem drinkers develop the coping strategies and social supports that encourage self-care.