Based on the study findings, the authors advise that clinical interventions should promote adaptive coping strategies that emphasize maintaining healthy behavior, effective problem solving skills, and stress-management techniques. Consistent with previous similar research with nonpsychiatric samples of adolescents, this study found that exposure to violence was associated with both increased substance use (sensation-seeking) and risky sexual behavior for both boys and girls. Exposure to violence was not associated with the motivation to engage in risky behavior as a means of escape, although motivation to cope with stress through escape was associated with a greater likelihood of substance use. Sensation-seeking was related to substance use and risky sexual behavior among all adolescents and with exposure to violence primarily among boys. The study data were from a larger longitudinal study that examined HIV risk behavior among youth in psychiatric care. Adolescents and their caregivers were recruited from four outpatient clinics in Chicago between 1999 and 2004. The study sample was 59 percent male, 61 percent African-American, 19 percent White, 12 percent Latino, and 8 percent biracial or other ethnicity. Lifetime exposure to five potentially traumatic events of interpersonal violence was determined from the PTSD (posttraumatic stress syndrome) module of the Computerized Diagnostic Interview Schedule for Children. Sexual behavior and drug/alcohol abuse were determined from self-reports. The sexual behaviors measured were ever having vaginal sex, having sex with two or more partners in the past 6 months, having sex while using drugs or alcohol, having vaginal sex at age 14 or younger, and inconsistent condom use. Coping with stress through escape was measured through self-reported reasons for engaging in risky behavior. 4 tables and 39 references