Substance and alcohol abuse are serious and emerging social issues in India, impacting individuals, families, and communities in both rural and urban environments. Substance and alcohol misuse contribute to various public health, social, and economic problems, such as domestic violence, mental health issues, school dropout, and lowered productivity. Recent national surveys such as the National Family Health Survey-5 and the Magnitude of Substance Use in India indicate alarming trends, especially among youth and vulnerable groups. Peer pressure, early initiation, poor mental health services, and changing social norms are some of the major drivers of this crisis. This chapter integrates existing tertiary literature to present a broad overview of alcohol and substance abuse in India. It delves into substance use’s social, cultural, and structural drivers, using conceptual frameworks from social epidemiology and behavioral health. The chapter also discusses the disproportionate vulnerabilities of tribal communities, slum dwellers, and youth in conflict with the law, with particular emphasis on how caste, poverty, and urban stress intersect with substance use forms. Methodologically, the chapter adopts a policy review approach and synthesizes findings from secondary data, government reports, and peer-reviewed literature. It assesses prevailing policy frameworks such as the Narcotic Drugs and Psychotropic Substances Act, prohibition laws at the state level, and the National Action Plan for Drug Demand Reduction. Particular focus is on the shortfalls of punitive strategies and the imperative for culturally sensitive, rights-based, and community-led responses. The chapter ends by recommending a multi-sectoral response based on public health, social justice, and preventive care. It calls for youth-oriented campaigns, school-level education, de-addiction centers, and increased community involvement. The chapter also outlines a road map to prevent substance-related harm and encourage healthier, more equitable communities in India.