The intuitively appealing hypothesized relationship between drug use and physical health status is reexamined critically in a longitudinal perspective. Individuals who were first surveyed in Houston junior high schools in 1971 are followed up through personal interviews in the fourth decade of life. In addition to focusing on the baseline effect of drug use on health, we include latent constructs reflecting deviance and psychological maladjustment as theoretically relevant antecedent and mediating variables. Using structural equation models, we found a positive, significant relationship between adolescent substance use and poor physical health in adulthood. Controlling for the spurious effects of adolescent psychological health, the baseline relationship is reduced, but remains significant. However, including a latent construct for adolescent deviance in the models attenuates the baseline relationship to insignificance. On the assumption that deviance is a cause, rather than a consequence of drug use, we conclude that the general deviant lifestyle, rather than drug use per se, adversely effects physical health, even into middle adulthood.