ABSTRACTRecovery from spinal cord injury (SCI) requires substantial coping by the patient. The coping process reflects both physical adjustment to permanent biological changes and psychological acceptance of these changes and their limitations to function. A history of family alcoholism appears as one prominent factor in persons with SCI. This factor is associated with several personality characteristics that could directly influence adjustment to the injury. As an initial exploration of this premise, the present study examined the relationship between family history of alcoholism and coping processes in SCI patients. Ninety volunteer subjects were selected from inpatient and outpatient populations of a Veterans Affairs spinal cord injury service. Based on structured interviews and responses to a standardized questionnaire, one group of 45 subjects, designated Family History Positive (FHP), were from families in which the father and at least one other second generation relative were alcoholics. The 45 Family History Negative (FHN) subjects were from families with no alcoholism history. Once assigned to a group, subjects completed the Ways of Coping Questionnaire. Compared to subjects with no family alcoholism history, FHP subjects reported significantly more use of constructive coping strategies as measured by the Ways of Coping Questionnaire, but their alcohol use and anti-social behaviors indicated that they were less effective in actual coping behaviors. Persons with SCI and a family history of alcoholism reported utilization of coping methods that differ from those used by patients with SCI and no family alcoholism history. From the perspective of treatment and rehabilitation, this finding suggests the need to consider different therapeutic approaches for these groups.(J Spinal Cord Med;19:78–86)