Heavy drinking couples in which one (i.e., discordant heavy drinking) or both (i.e., concordant heavy drinking) partners drink alcohol heavily are at greater risk for intimate partner violence (IPV) than couples in which neither partner drinks heavily (i.e., concordant nonheavy drinking). Additionally, the risk for IPV is particularly high among discordant as compared to concordant heavy drinking couples. Despite the fact that individuals who drink heavily often also use other drugs, the extent to which couples' use of other drugs interacts with heavy drinking patterns remains unknown. The current study examined differences in psychological and physical IPV perpetration as a function of couples' heavy drinking and other drug use patterns. The sample included 337 couples in which at least one partner reported a history of heavy drinking and IPV in the current relationship. Results of dyadic path models showed that concordant drug using couples who engaged in either discordant or concordant heavy drinking were at greater risk for male- and female-perpetrated psychological IPV compared to concordant nondrug using couples (regardless of heavy drinking) and concordant nonheavy drinking couples (regardless of drug use). Associations between heavy drinking and other drug use patterns on physical IPV perpetration were not statistically significant. These findings show that a pattern of concordant drug use paired with discordant or concordant heavy drinking places couples at particularly high risk for psychological IPV. Clinicians working with couples affected by IPV may benefit from paying attention to the dyadic dynamics of heavy drinking, other drug use, and IPV.