This note reviews recent literature relating to the use of alcohol, tobacco, and intravenous drugs in the countries of Central and Eastern Europe and the former Soviet Union. Trends in substance use among subpopulations are discussed in relation to changes in the major population health indicators since 1990. This article summarizes recent work into understanding the role of substance use and misuse in the region in explaining demographic developments in terms of life expectancy and population growth. In 1993, 80% of Russian males drank, and among these, alcohol intake averaged near 600 grams per day. Smoking is much more prevalent among Russian men (61.4%) than among women (10.3%). In 2003, 185.8 per 100 thousand Russian men were drug addicted. High rates of male alcohol abuse, suicide, accidents, violence, and cardiovascular disease appear to be major causes of the large falls in life expectancy and rising gender gaps in life expectancy in the region. Life expectancy at birth in Russia was estimated at 60.5 years for males and 74 years for females in 2005. Russia's population is now declining at a rate of 0.37% per annum, and with more than 1% of the population estimated to be HIV positive, it is likely that this population decline will accelerate further in the near future. Many of these population trends are mirrored across the former Soviet Union.