According to the analysis, substance use disorders are increasingly going to be found in low-income countries. The main argument is two-fold: substance abuse is likely to increase during the next few decades; and (2) economic development will increase alcohol use in low- and middle-income countries. These countries are also likely to experience an increase in illicit substance use and many of them are already in the early stages of a tobacco epidemic. Current research indicates that alcohol and tobacco are the first and third most significant risk factors contributing to poor health outcomes and premature death in low-income countries. Indeed, research has indicated that in all countries, hazardous and harmful substance use is concentrated in socio-economically disadvantaged groups. The author argues that the extent and related harms of global substance abuse during the next few decades will in large part be predicted by occurrences in Southeast Asia and the Western Pacific. These areas are home to nearly half the world’s population and there is compelling evidence that substance use in these areas is increasing. Despite the global increase in substance use, the author contends that the United Nations Conventions on illicit drugs are having a positive impact. Evidence of this impact is offered that shows that illicit drug use is less than one-tenth that of alcohol use and less than one-fifth that of tobacco use. Data for the analysis was largely drawn from the World Health Organization’s Global Burden of Disease study, which described the current use of alcohol, illicit drugs, and tobacco throughout the world. The study also considered the impact of poverty and market forces on the use of substances. Figures, tables, references, appendix