Background and aim Temperature affects human health, but there is limited evidence on how temperature increases are associated with alcohol- and substance-related disorders. Over half of American adults regularly consume alcohol or substances. Plausible behavioral and physiological pathways exist for the association, including more perspiration in warmer weather, and temperature-dependent efficacies of substances. Our aim was to comprehensively evaluate associations between ZIP Code-level temperature and alcohol- and substance-related disorder hospitalization rates in New York State (NYS). Methods Using a case-crossover design coupled with distributed lag non-linear terms, we examined how ZIP Code-level temperature was associated with daily alcohol- and substance-related disorder hospitalization rates up to six days before hospitalization, and how these estimated associations varied by location, age group, sex, and social vulnerability. Hospitalization records in NYS were collected from the NY Department of Health Statewide Planning and Research Cooperative System (SPARCS) along with a comprehensive record of temperature over 20 years (1995–2014). Daily individual-level hospitalizations were grouped into two causes (alcohol-, substance-related disorders) and four sub-causes (cannabis-, cocaine-, opioid-, sedative-related admissions). Results We found a near-linear increase in alcohol-related disorder hospitalization rates between -28°C and 10°C (19.3% [95%CI,9.8%–28.9%]) and between 10°C and 20°C (4.7% [95%CI,3.3%–6.2%]), above which the association flattened at 32°C for a 6.0% [95%CI,1.5%–10.5%] increase relative to 10°C. Substance-related disorder hospitalization rates increased between -29°C and 10°C (36.1% [95%CI,26.1%–46.2%]) with no change from 10°C to 32°C (1.6% [95%CI,-2.8%–5.9%]). For cocaine, there was a near-linear increase from the coldest temperature to the mean (-29°C to 10°C) and an increase in rates above mean temperature, up to an 5.4% [95%CI,2.2%–13.0%] increase from 10°C to 32°C. Conclusions From 1995–2014, rising temperatures were associated with higher hospitalization rates for alcohol- and substance-related disorders up to a threshold, above which no association was detectible.