Although psychotropic medications are commonly used with older adults who have mental retardation, patterns of medication use for this group are not easily determined. Our objective was to explore relations between prescribed psychoactive treatments and rated behavioral difficulties. Adults with moderate mental retardation living in congregate and group care settings were rated by care providers using a standard behavior rating instrument. Older adults demonstrated a tendency toward higher medication utilization. Results indicated higher drug utilization in the larger setting despite the fact that behavior problems and cognitive level was matched across all settings. Medication utilization appears to be related to multiple factors, not only the behavioral or cognitive characteristics of adults with mental retardation.