This study examined the relationship between psychological birth order and substance abuse and suicide in adolescents. It was hypothesized that adolescents operating from a perceived inferior position as measured by the Psychological Birth Order Instrument would be more likely to abuse substances and/or engage in self-destructive behavior. Ninety-five adolescents from Southern Arizona volunteered to participate in this study. The forty-eight treatment subjects were current in-patients at a psychiatric hospital. The control group consisted of forty-seven high school students. The results indicated that there was a difference in perceptions between adolescents in treatment versus those not in treatment for substance abuse and/or suicide. There was a significant relationship at the.005 level and it was concluded that adolescents operating from a perceived inferior position are more likely to abuse substances and/or attempt suicide.