The widespread use and misuse of alcohol, drug and other psychoactive substances are major health and social concerns that affect the lives of many. The social and health sequelae of psychoactive drugs and alcohol are preventable and manageable with minimal interventions. Nurses and other health workers can effectively respond to substance misuse problems and their existing generic skills can be easily adapted in working with substance misusers. This paper considers some of the issues such as the extent of the problem, attitudinal considerations, response to substance misusers and a brief outline of the role of the nurse. The urgent need for education and training in substance misuse and addictive behaviour for nurse practitioners is also addressed.