The proliferation of controls over drugs and drug users in countries around the world over the last century has in part been a result of poor understanding of the substances themselves and/or those that use them. A common thread running through the development of such controls is recourse to images and beliefs about the substances that are exaggerated and often false. Many of these beliefs-despite a contrary evidence base-continue to prevail in discourses around drugs. Fundamental to this is a continued lack of understanding of how risks and harms manifest and a tendency to generalize such experiences as an inevitable outcome of drug use. Drugs, their use, and the outcomes of that use, are not pharmacologically determined, but are situated and contingent. The concept of drug, set and setting (and process) enables us to better understand drug effects and how they can produce different, including non-problem, outcomes, be controlled by both individuals and groups, and have outcomes for societies that are positive as well as negative. Understanding "how" drugs are used and the extent to which they are utilized provides better insight into the real nature of drug use in any one context and counters simple ideas about generic, simple, and inevitable (destructive) outcomes. Failure to meaningfully contextualize risks has resulted in abuses of individual, social, cultural rights and traditions and ecological damage.