By examining measures of psychological distress in heroin-dependent (HD) and non-opioid-substance-dependent (NOSD) adolescents, this study attempts to ascertain whether mental health symptoms differ according to drug use predilection or gender. The Beck Youth Inventory scores of 52 HD young people and 68 NOSD youths were retrospectively reviewed. HD adolescents demonstrated poorer self-concept as well as greater anxiety, depression, and disruptive behavior than the NOSD group. Female HD adolescents reported more mental health problems related to self-concept and disruptive behaviors than male HD adolescents. While causation cannot be stipulated, this study points to the complexity of mental health needs in adolescent drug users.