In 2002, the NSW Department of Health, in conjunction with The Cancer Council NSW, carried out the NSW School Students Health Behaviours Survey. The methodology and summary descriptive results have been previously described [NSW Department of Health. The health behaviours of secondary school students in New South Wales 2002. N S W Public Health Bull 2004; 15(S-2): 1–86]. In the survey, 18% of NSW secondary school students reported high levels of psychological distress, 30% reported recently using alcohol, 13% reported recently using tobacco, and 9% reported recently using cannabis. With regard to the other illicit drugs, 2.0% reported recently using amphetamines, 1.0% cocaine, 1.4% hallucinogens (LSD, heroin) and 1.9% ecstasy. The survey did not, however, examine associations between substance use and high levels of psychological distress. These associations are described in this article.