Existing research reveals that early child abuse victimization and substance use and misuse in adulthood have a major relationship. To enhance the understanding of the relationship, we proposed models linking child abuse victimization to substance use and misuse later in life through a social learning process and a psychological strain process channeled through deviant peer association, perceived harms of substance use, self-esteem, and psychological distress. Using data from a probability sample of 2,799 adults in a Chinese city, we conducted an SEM analysis to test the relationships among the conceptual constructs. Child abuse victimization exhibited positive and indirect effects on multiple forms of substance use and misuse, including frequency of tobacco use, frequency of binge drinking, and illicit drug use. Deviant peer association and perceived harms of substance use mediated all effects of child abuse victimization on substance use and misuse in adulthood. Self-esteem and psychological distress, however, played varied roles in the mediating processes. Overall, child abuse victimization demonstrated a significant indirect effect on substance use and misuse in adulthood. To understand whether child abuse victimization is related to substance use behavior in adulthood, examining the indirect links between child abuse victimization and substance use and misuse is critical.