High school students (n = 1983), 14-18 years olds, were surveyed regarding the incidence of injury and substance use at the time of the injury in the prior 6 months. Alcohol or other drugs were reported particularly often for falls, cuts, and gun and assault injuries. Alcohol or other drugs were reported to be involved in a substantial proportion of injuries resulting in medical care, most notably for gunshots (70%), pedestrian injuries (42%) and physical fights (38%).