Substance use among college students is increasing in India. This may be linked to a few contextual factors associated with developmental changes. This narrative review used articles about substance use prevalence among college students in India published between 2010 and 2021. Keywords such as college students, undergraduate students, university, India, substance use, drug use, and drug addiction were used in PubMed, Google Scholar, and ProQuest databases. A total of 12 articles were included in the study. Overall, substance use prevalence among college students ranged from 17.15% to 60.26%. Substance use was higher among professional course students (medical: 17.15% to 60.26% and engineering: 26.87% to 47%.) than general degree (arts, commerce, and science) students (31.3% to 31.8%). Tobacco, alcohol, and cannabis were the most used substances. Engineering and medical students had greater accessibility and affordability to illicit substances than general degree students. Stress, peer pressure, curiosity, social celebration, health and academic benefits, family and personal problems, easy availability, and experimental use were associated with substance use. This study has generated insight into many factors associated with substance use among college students in India.