The present study investigated hypotheses focusing on the relationship between youths with disruptive behavior disorders (DBDs) and caregiver strain. Furthermore, analyses explored whether the relationship between youths with DBDs and caregiver strain depended on the amount of service use in three separate settings (outpatient, school-based, and inpatient). Participants were high-risk youths from the Patterns of Care study who were randomly sampled from one of five public sectors of care. Findings supported hypotheses linking caregiver strain to individuals caring for youths meeting diagnosis for DBDs. Furthermore, the relationship between youths with DBDs and caregiver strain varied depending on the amount of inpatient service use, but the relationship did not differ across levels of outpatient and school-based counseling service use. These findings suggest the importance of addressing caregiver strain when developing treatment plans for youths with DBDs.