The research took place at the R Adams Cowley Shock Trauma Center, a regional trauma center for central Maryland and an areawide trauma center for Baltimore. The participants included persons ages 18 or older who were admitted from the injury scene, stayed 2 days or longer, and had intact cognition. The psychoactive substance use disorders were diagnosed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Disorders were categorized as drug abuse or drug dependence and past or current (within the last 6 months). Results were analyzed with respect to demographic factors, injury type, and blood alcohol concentration and urinalysis, using chi-square and logistic regression techniques. Findings revealed that 54.2 percent of the 1,119 participants had a diagnosis of drug abuse in their lifetime. Approximately 90 percent of the diagnoses were for drug dependence; more than 62 percent were currently involved. Overall, 24.1 percent of the participants were currently alcohol dependent and 17.7 percent were currently dependent on other drugs. Findings indicated that a high percentage of seriously injured persons treated in trauma centers are at risk of having current drug disorders and that those with positive toxicology screening results or positive screening questionnaire results should be referred for formal evaluation and treatment. Tables and 50 references