Statewide nursing student alcohol and other drug (AOD) use attitudes and behaviors were assessed. Response was 929/2017 (46%) (practical nursing [n = 173/301] 57.3%; diploma and associate degree in nursing [n = 282/417] 67.6%; bachelor of science in nursing [n = 474/1299] 36.5%). Nearly 44% reported inadequate substance abuse education. Past-year AOD use included tobacco 36.9%, marijuana 6.8%, sedatives 4.6%, and opioids 2.6%. Past-year AOD-related events included blackouts 19.8%, class/work under the influence 6.3%, patient care under the influence 3.9%, lowered grades/job evaluations 6.6%, and legal charges 3.6%. Heavy drinking was reported by 28.9%. Practical nursing (PN) students most often reported tobacco use and sedative use, whereas Bachelor of Science in nursing (BSN) students most often reported marijuana use. Family histories of alcohol-related problems and drug-related problems were reported, respectively, by 48.1% and 19.2% of respondents; 51.1% reported at least one of these. PN students most often reported such family histories. Nursing educational systems should proactively address student AOD prevention, education, and assistance. (Contains 4 tables.)