Two studies investigated self-injurious behavior (SIB) in a man with profound handicaps. Study 1 examined the effects of contextual variables on the rate of SIB during differing environmental conditions and behavioral states such as drowsy, quiet alert, active alert, agitated/crying. Results indicated that the rate of SIB varied depending on contextual conditions and behavioral state. The results also suggested that the function of SIB changed depending on the behavior state of the individual. Study 2 examined the effects of a treatment program that involved manipulating the environment depending on behavioral states, and then adding medication to the treatment plan. Results indicated that the treatment plan was effective in reducing self-injurious behavior and that the percentage of time spent in alert states increased when the treatment plan was implemented. Both SIB and behavioral state were positively affected when Fluphenazine was added to the treatment plan.