Limited research exists regarding gender differences among adolescent-substance users who report traumatic stress (TS) symptoms. This study included 274 male and 104 female adolescents enrolled in 4 drug treatment programs in Arizona. Comparisons were examined between males and females and those with low versus acute levels of TS symptoms with regard to substance use, mental health, physical health, and HIV risk behaviors. Results indicate that significant differences existed between males and females as well as those with low TS symptoms versus those with acute TS symptoms for substance use issues and problems, mental and physical health problems, and sexual activities associated with HIV risk. Females and those with acute TS symptoms consistently presented with more problems than did males and those with low TS symptoms. In addition, females and those with acute TS symptoms were more likely to report mental health problems, reported greater health problems, and reported riskier behaviors. In summary, a substantial proportion of adolescents entering substance abuse treatment present with TS symptoms. Treatment providers should consider addressing related issues of mental health, physical health, and HIV risk behavior either through integration of services within the program or through coordination with other types of treatment providers. Tables and references