Punjab, a border state, has been at the center of a raging public health debate due to substance use and misuses. News reports about over-dose deaths, crimes, drug trafficking, the rise in misuse of pharmaceutical drugs and illicit liquor problem have dominated media headlines, public discourse and election promises to effectively control substance-abuse problems. Concerns over this public health crisis have been longstanding and multifaceted, linked to both Punjab’s agrarian prosperity and subsequent stagnating economy, as much as its strategic geopolitical location as a border state located in between international drug trafficking networks. This chapter examines academic studies and debates around the problems of substance abuse in Punjab. It will not only primarily draw on sociological and related literature but also refer to few relevant literature from public health, for an interdisciplinary approach is relevant to comprehend substance use problems. Both statistics from epidemiological studies and qualitative research reveal that alcoholism and pharmaceutical drugs addiction are serious issues among younger demographics in rural and urban areas. The chapter demonstrates the significance of epidemiological surveys which are crucial to estimate patterns and prevalence of substance use, but also argues that literature which explains historical-sociocultural dimensions, economic factors and other interrelated complexities that create an enduring problem are also necessary. The later part examines some of the policy and practice initiatives to identify gaps. The paper discusses the challenges in rehabilitation and healthcare delivery of substance use disorders and measures toward public health to deal with addiction and prevention. It concludes that more efforts need to be directed toward treatment, rehabilitation and prevention of substance misuse.