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Suicide is a leading cause of mortality in persons with spinal cord injury (SCI), with 5–10% of individuals with SCI committing suicide by overt means (e.g., M. J. DeVivo, K. J. Black, J. S. Richards, & S. L. Stover, 1991; S. W. Charlifue & K. A. Gerhart, 1991). This current case study describes a psychological autopsy of a 33-year-old man with SCI with a history of chronic pain and substance–drug abuse who committed suicide 3 years and 7 months following a T12 incomplete SCI. The results of postmortem interviews helped clarify events and factors that may have led to his suicide. Contributory factors identified included poor social adjustment, poor body image, unresolved chronic pain, family problems, and prolonged history of substance and prescription drug abuse.