Noting sexual abuse among women is widespread in the United States, the authors of this article argue that there is a clear relationship between childhood sexual abuse and substance use and abuse. Presenting a secondary analysis of data collected from the Houston, TX, Safer Choices 2 Program from October 2000 to March 2001, the authors examine survey results from 282 female seventh and eighth grade students from 10 alternative schools. Logistic regression analysis of results from survey questions concerning the students’ use of marijuana, cocaine, codeine, inhalants, heroine, amphetamines, hallucinogens, steroids, and fry/dip indicated that an individual’s sexual abuse history was significantly associated with a lifetime of substance use and abuse. This research demonstrates that the needs of sexually abused children are significantly different from those who have not been victimized and that adolescent treatment workers need to pay attention to the special needs of abused children. Tables, references