In India, it is estimated that 75 million people are alcohol users and nearly 3 million are opioid users.(1) Of these, there has been a noted prevalence of 19.78-21.4%(2) of alcohol use and 5% of alcohol dependence in Indian population.(3) The prevalence of opium use in India has also been increasing and it is now considered to be a ’party drug’ or ’relaxation drug’. Several studies have described the prevalence of opium abuse to be 1.51-2%(3,4) although a recent study notes it to be around 0.4%.(2) Yet, there is a concerning increase in the social acceptance of alcohol even for frequent self-induced intoxication and easier access to ’hard drugs’ like opioids is now responsible for driving adolescents toward substance use and a trend is being noted toward lower ages of onset of both alcohol and opioid use. Even though opium use is generally frowned upon, alcohol use is widely accepted. There is, therefore, an urgent need for reduction in the demand of drugs of addiction, both legal and illegal, which may otherwise lead to numerous health, family and societal consequences. One of the ways this can be made possible is by identifying and preventing the development of dependence in both alcohol and opioid users. This study is therefore aimed at: Studying the clinical course of development, in terms of ages, order of onset and duration of criteria of ICD-10 dependence, of both alcohol and opioid dependence. Comparing and contrasting the two substances to evaluate differences if any, to formulate a strategy for primary prevention. Materials and Methods Consecutively admitted patients of ≥18 years of age for treatment of dependence in the period of August 2005 to May 2006 in Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India with ICD-10 DCR(5) diagnosis of alcohol dependence syndrome or opioid dependence syndrome (made by a senior resident/senior consultant) and giving written informed consent were recruited for the study. Subjects with other co-morbid psychiatric disorders/substance dependence/general medical condition and with MMSE score <24 and were excluded from the study. All the subjects participated in the personal face to face interview after medically supervised withdrawal using alcohol or other drug (opioid) section of SSAGA-II(6) (revised in 1997) according to individual diagnosis of patient. The details of this instrument and the methods have been given in an earlier paper.(7) Since it was a retrospective recall study, questions were framed individually to trigger the recall with reasonable accuracy using anchor questions to memorable events, tagging the questions with specific examples and defining the technical terms.(8) All ratings were done by an investigator blind to the diagnosis and current status of the subjects. The data were statistically analyzed by means of T-test for descriptive variables and the Chi-squared test for categorical variables.