This paper attempts to map substance use and abuse in South Africa by gathering data from multiple sites throughout the country. Less than 3% of people requesting treatment at five selected locations in South Africa (Cape Town, Durban, Port Elizabeth, Gauteng and Mpumalanga) reported ecstasy as their primary drug of choice. This remained true from 1997 to 1999. Data from every sub-set suggests that alcohol, followed by cannabis and a region-specific combination of cannabis and methaqualone ("white pipe") are the most commonly used and abused substances and cause the most harm. Little or no ecstasy use was reported to occur in some samples (in people admitted after trauma, in psychiatric admissions, people arrested for various offenses). The highest percentage of people who listed ecstasy as their drug of choice were found in drug abuse treatment centers in Durban; 1% of 817 in 1997 in Site B, 3% of 817 in 1998 at Site A, and 1% out of 682 at Site A in 1999. In 1997, 1% of 2162 people surveyed at substance abuse treatment centers reported that ecstasy was their preferred drug, and 1% of 1527 people surveyed in 1999 reported ecstasy to be their preferred drug. Ecstasy use among those seeking treatment for substance abuse were very low in Port Elizabeth, (under 1% or none from 1997 until 1999), Gauteng (under 1% in 1998 and 1999) and Mpumalanga (under 1% in the 1999, the first year data was collected from this area). 4% of male high school students and 3% of female students out of 2379 11th-year high school students in Cape Town reported ever using ecstasy, but no ecstasy use was reported in a sample of 2334 students in Port Elizabeth. Rates of binge drinking and cannabis use were much higher. Gender differences in other drugs, such as alcohol or cannabis, tended to be greater, with men generally being more likely to use a substance than women. Ecstasy use appears to be rather infrequently used in South Africa and does not appear to incur high costs in terms of health care or crime. It is possible that heavy sampling from drug treatment facilities may have lead to the underestimation of ecstasy use in the general population.