This annual trend report provides a wealth of information on the misuse of alcohol, tobacco, and drugs in the State of Washington and the effects of substance abuse on an individual’s health and well-being. In addition, the report highlights new research in the area of substance abuse among youth and adults. The report is divided into six main sections: (1) economic costs of substance abuse; (2) substance abuse prevalence and trends; (3) areas of substance abuse impact; (4) prevention and treatment; (5) outcomes; (6) policy issues confronting Washington State; and (7) data sources. New to this report is the documentation of the use and effectiveness of evidence-based prevention practices within communities, the effectiveness of treatment for individuals addicted to methamphetamine. In addition, there are three new essays on policy issues confronting Washington State which include: (1) Brief Interventions in Emergency Department and Health Care Settings; (2) Substance Abuse and Child Welfare; and (3) Treatment for Nicotine Dependence. The report is intended as a guide in continuing efforts to improve the health and safety of the people living in the State of Washington. Tables, charts, and graphs