Although most drug abusers have experienced a variety of psychotropic agents, many abusers experience a prolonged and distinct preference for a particular drug. To examine the relationship between drug preference and personality, preferential abusers of heroin and amphetamine were interviewed while abstinent. Qualitative analysis of the data suggests a distinct relationship between personality style and drug preference in this sample.The drug of choice appears to be syntonic with the abuser's characteristic modes of adaptation. Whereas the heroin addict reduces anxiety via repression and withdrawal, the amphetamine abuser utilizes a variety of compensatory maneuvers to maintain a posture of active confrontation with the environment. The heroin abuser's low self-esteem and personalized style are in sharp contrast to the narcissistic self-inflation and abstract communication of the amphetamine abuser. The specific drug effects of “satiation” (heroin) and “activation” (amphetamine) temporarily aid in the reduction of anxiety by bolstering characteristic modes of defensive functioning.The origins of preferential drug abuse may be such drug-induced altered ego states. These may recapture a series of similar experiences, the originals of which appear to lie in specific phases of child development. A particular drug may thus facilitate a specific regressive solution to conflict and may, therefore, be preferentially chosen. Thus, in addition to the pressures of physiological dependency and social setting, drug abuse appears also to be determined by the convergence of pharmacological effect and premorbid patterns of coping with anxiety. A complete understanding of drug use will require clarification of both the similarities and differences found between preferential users of different drugs.