Longitudinal studies of adults have reported finding insomnia to significantly predict onset of substance abuse. This study estimated the association between sleep problems and substance use among adolescents in the context of psychiatric problems. Data come from the US National Household Survey on Drug Abuse 1994–1996 that included 13,831 adolescents. Use of cigarettes, alcohol and any illicit drug were each associated with adolescents’ reports of having frequent sleep problems, adjusting for age, sex, race and family income (odds ratios ranging from 1.5 to 3.8). Adjusting for internalizing (e.g. depression and anxiety) and externalizing (e.g. deviance and aggression) problems reduced the associations between sleep problems and use of these substances, suggesting that part of the association is attributable to psychiatric problems. The part of the association not attributable to psychiatric problems was limited to the associations between sleep problems and use of illicit drugs. These results suggest that the relationship between sleep problems and drug use/abuse must be viewed in the context of psychiatric problems. Longitudinal research that employs more specific measures of sleep problems is indicated. Such research may provide information on the relationship of sleep problems to the immediate health and well being of adolescents, as well as their trajectories into adulthood.