The use of psychoactive substances (tobacco, alcohol, illicit drugs) remains high in France, although downward trends are being observed, particularly among young people. Tobacco remains the leading cause of preventable death, with 75,000 deaths in 2015, followed by alcohol (41,000 deaths). The overall social cost is considerable, reaching 266 billion euros in 2019. Social inequalities are significant for tobacco, less so for alcohol. Vaping is on the rise and is a particular concern among adolescents, among whom it is now more prevalent than smoking. Levels of illicit drug use are much lower, including for cannabis, the most commonly used illicit substance, particularly among young men. Despite the progress made, prevention and support for users remain essential to limit health and social impacts.