Despite ongoing concern about substance use during adolescence, very little is known about alcohol and drug use among teens living in affluent social settings. In this longitudinal study, cluster analysis was used to characterize patterns of substance use and change in other dimensions of psychosocial adjustment within a cohort of 292 high school students (54% girls) living in an affluent, suburban community. When compared with a cluster of students reporting minimal use, clusters reporting escalating, declining, and persistently high use consistently demonstrated relatively poorer psychosocial adjustment. Moreover, other dimensions of psychosocial adjustment remained relatively stable despite changes in substance use, and there were relations involving substance use and other aspects of psychosocial adjustment that may be specific to this social setting. The findings highlight the need for preventive intervention grounded in a clear understanding of developmental process occurring within populations of affluent, suburban teens.