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This chapter begins with a brief history of the ways in which alcohol has been ingrained in American culture since the arrival of European settlers and their enslavement of African people. The chapter then addresses important aspects of alcohol and other drug use among college students. Because of the popularity of alcohol and cannabis among college students, they occupy the primary focus of the chapter, although other psychoactive drugs are briefly discussed as well. The chapter draws from data collected by the Healthy Minds Study, the Center for Collegiate Mental Health (CCMH) and the American College Health Association (ACHA) in describing the prevalence of alcohol and cannabis use among college students, as well as trends in the use of both substances. The reasons college students drink and use cannabis are explored, as are the many consequences, including academic, legal, physical and interpersonal. The chapter examines a number of prevention strategies that colleges have used to minimize the negative consequences of substance use, including large-scale scare tactics, educational efforts and norming campaigns, as well as individually tailored programs; the effectiveness of each is reviewed.

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