Violence is a leading cause of injury among youth 15–24 years and is frequently associated with drug use. To inform optimal violence interventions, it is critical to understand the baseline characteristics and intent to retaliate of drug-using, assault-injured (AI) youth in the Emergency Department (ED) setting, where care for violent injury commonly occurs. A new research study published in the journal Addictive Behaviors looks at AI youths admitted to an urban ED. Youths (ages 14–24) endorsing any past six-month substance use (n = 350), and a proportionally-sampled substance-using comparison group (CG) presenting for non-assault-related care (n = 250), were recruited and completed a baseline assessment (82% participation). Medical chart review was also conducted. Conditional logistic regression was performed to examine correlates associated with AI. Results showed that over half (57%) of all youth met the criteria for drug and/or alcohol use disorder, with only 9% receiving prior treatment. Among the AI group, 1 in 4 intended to retaliate, of which 49% had firearm access. From bivariate analyses, AI youth had poorer mental health, greater substance use, and were more likely to report prior ED visits for assault or psychiatric evaluation. Based on multivariable modeling, AI youth had greater odds of being on probation/parole (AOR = 2.26; CI = 1.28, 3.90) and having PTSD (AOR = 1.88; CI = 1.01, 3.50) than the CG. AI youth may have unmet needs for substance use and mental health treatment, including PTSD. These characteristics along with the risk of retaliation, increased ED service utilization, low utilization of other health care venues, and firearm access highlight the need for interventions that initiate at the time of ED visit.