Alcohol use among underage youth has a major impact on public health, accidents, fatalities, and other problem behaviors. In Israel, alcohol use, binge drinking, and related problem behaviors are a growing concern. The purpose of this study was to examine underserved and underreported Ethiopian origin youth by comparing their substance use patterns and behavior with other high-risk youth. Data were collected from a purposive sample of boys of Ethiopian, former Soviet Union, and Israeli origin who were receiving treatment for drug use. Youth were asked to complete a simply worded self-report questionnaire developed for monitoring substance use and related problem behaviors. Ethiopian youth reported higher rates of family unemployment and public welfare dependence, last 30-day consumption of beer and hard liquor, serious fighting, and achievement decline when in school compared with the other youths. Findings highlight the need for ethno-cultural specific prevention and intervention efforts and further research of this high-risk, underserved group of immigrant origin youth.