Drug and alcohol abuse is identified increasingly in Latin America as a significant source of insecurity. Yet, there has been little research on consumption and on the social norms surrounding it. This paper explores the nature of drugs and alcohol consumption among urban poor communities in Colombia and Guatemala, where use is widespread. It also looks at levels of community tolerance of drug and alcohol use, and in particular at the complex ways in which these attitudes relate to levels of violence and insecurity. The paper, drawing on the perceptions of the poor themselves, argues for the need to take the issue of community tolerance into account in designing responses which, in order to be effective, should also be linked with wider sustainable development goals.