Although a relationship between childhood sexual abuse and later alcohol use among women has been documented, little is known about the pathways that link these two variables. A tension-reduction hypothesis posits that emotional distress precedes substance use. To test this hypothesis, a sample of 3,220 women was selected and interviewed on two occasions 1 year apart; the interviews assessed childhood rape history, lifetime PTSD symptoms, and lifetime alcohol use. Path analytic techniques were used to assess the mediating role of PTSD symptoms on the relationship between childhood rape and subsequent alcohol abuse. Findings show that a history of childhood rape doubled the number of alcohol abuse symptoms that women experienced in adulthood. Path analysis and cross-validation results showed significant pathways that connect childhood rape to PTSD symptoms and PTSD symptoms to alcohol abuse. The findings of this study suggest that PTSD symptomatology that develops after childhood rape may be one of many variables that affect alcohol abuse patterns in women who were victims of childhood sexual abuse. 1 table, 3 figures, and 34 references