Substance abuse such as alcohol consumption and smoking serve as profound indicators for Tuberculosis (TB). Tribes in rural India are the vulnerable population for various diseases and substance abuse is more prevalent among them. Very few studies have been conducted to find the substance abuse and its association with TB among tribes in Kerala. Hence, we sought to understand the prevalence of substance abuse among tribes, and its association with chest symptomatic cases and cases with history of TB. This study aimed to identify the predictors of negative social behaviours among tribes and their association with chest symptomatic cases and history of TB. It was part of a collaborative research program to estimate the burden of TB amongst tribal groups, by ICMR, NIRT, Chennai and SRM University, Kancheepuram and Population Research Centre, Kerala conducted in 2018. This article presents the prevalence of substance abuse (tobacco and alcohol) among tribes, and its association with chest symptomatic cases and cases with history of TB. The study also tried to find out the predictors of substance use among tribes. Among 2609 tribes interviewed, 14.6% were smokers, 47 percent were used smokeless tobacco and 29% were consumed alcohol and only 20 respondents reported using drugs. Significant association of chest symptoms and TB history status with district, category of tribe, age, education, marital status, and nutrition are observed in the study. Chest symptomatic cases and those who had the history of TB had a highly significant association with use of smokeless tobacco and smoking. However, the study could not find a significant difference between those consuming alcohols. The predictors of substance abuse were found to be in higher age groups, low education, being in the low socio-economic profile and in the low BMI. To attain health goals like zero TB, control of substance use is an essential component especially among tribal communities. This study highlights the importance of education and better living conditions in reducing negative health behaviours among tribes.