Background: Despite previous research indicating an adolescents' alcohol, tobacco, and other drug (ATOD) use is dependent upon their sex and the sex composition of their social network, few social network studies consider sex differences and network sex composition as a determinant of adolescents' ATOD use behavior. Methods: This systematic literature review examining how social network analytic studies examine adolescent ATOD use behavior is guided by the following research questions: (1) How do studies conceptualize sex and network sex composition? (2) What types of network affiliations are employed to characterize adolescent networks? (3) What is the methodological quality of included studies? After searching several electronic databases (PsycINFO, EBSCO, and Communication Abstract) and applying our inclusion/exclusion criteria, 48 studies were included in the review. Results: Overall, few studies considered sex composition of networks in which adolescents are embedded as a determinant that influences adolescent ATOD use. Although included studies all exhibited high methodological quality, the majority only used friendship networks to characterize adolescent social networks and subsequently failed to capture the influence of other network types, such as romantic networks. Conclusions: School-based prevention programs could be strengthened by (1) selecting and targeting peer leaders based on sex, and (2) leveraging other types of social networks beyond simply friendships.