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To identify rates of substance misuse with onset before and after spinal cord injury (SCI) and to investigate whether patients with a history of substance misuse are more likely to report being intoxicated at the time of injury.One hundred twenty-four veterans with traumatic SCIs.Alcohol and nonalcohol psychoactive substance use disorder (PSUD) sections of the Structured Clinical Interview for DSM-III-R.Forty (32%) had a lifetime PSUD. Of those, 55% recalled the onset of their PSUD occurring preinjury, 27.5% recalled the onset occurring postinjury, and 17.5% could not recall their age at onset. Compared with participants who reported postinjury onset of PSUD, those with reported preinjury onset were more likely to report intoxication at time of injury. No significant relation was found between intoxication at injury and presence of a lifetime PSUD.Intoxication at injury does not necessarily substantiate the existence of an underlying substance misuse problem.