India has a history of use of plant products such as cannabis, opium, and home-brewed alcoholic beverages. This history has developed within a defined sociocultural framework over five millennia. Cross-sectional epidemiological studies in the field of substance use in different parts of India show that certain social groups are more vulnerable to substance use. Caste, religion, and local customs and traditions have a significant role in the choice of drugs, their consumption, and their control in rural/semiurban populations. The intercultural barriers are diminishing in urban populations, and even alien drugs such as heroin have been introduced. The current surge in the use of synthetic substances of differing dependence potential has altered traditional patterns of substance use, especially in the metropolitan cities and a few northeastern Federal States. Heroin, Charas, and distilled alcoholic beverages have become the new preferred mood-altering substances in urban areas of the country. Along with this, a new trend is emerging with regard to the socio-demographic characteristics of users. There is an increase in the number of adolescent/youth drug users, and drug use is increasing among socially deprived low-income groups and slum populations. 5 tables and 43 references