This study examined relationships between medical complications resulting in hospital stays and alcohol and illicit substance use in 71 persons with recent spinal cord injury (SCI). At 5 intervals after injury, medical records were reviewed for pressure ulcers and urinary tract infections (UTIs). Abstainers with histories of drinking problems before SCI were at greater risk for UTIs from 7 to 12 months after injury and for longer hospital stays. Former drinkers may not have implemented the self-care skills that were a focus during inpatient rehabilitation. Preinjury illicit substance abuse was related to an increased risk of pressure ulcers 30 months after SCI. Clinical implications are clear: Psychologists should inquire about substance use patterns, monitor psychological well-being, and explore the ways in which self-care habits are related to substance use.