Introduction and Aims. A survey was conducted in 2004-2005 to investigate the risk of drug-related harm among Chinese, Vietnamese, Italian, Pasifika, Arabic-speaking and Spanish-speaking communities in Sydney. Design and Methods. A self-completion questionnaire, available in six languages, was distributed by bilingual field staff. A representative multistage clustered sampling design was used. Comparisons were made with the New South Wales general population using the results from the 2004 National Drug Strategy Household Survey. Results. The obtained sample was 2212 respondents; 50% completed the questionnaire in English. Daily tobacco use was higher than the general population among Vietnamese men (30%), Italian men (22%) and Pasifika men and women (25%). Reported use of alcohol and other drugs was lower than the general population in all six surveyed communities. Of the six communities, Pasifika had the highest rate of short-term risky drinking (22%). Discussion and Conclusions. Smoking cessation programs should prioritise communities with higher or equal rates of daily smokers compared with the wider New South Wales population. Focus areas vary between the communities, and include increasing help seeking and improving quitting success rates. Short-term risky drinking was not as prevalent among the surveyed communities; however, results suggest a need for prevention targeting Pasifika communities. Understanding the prevalence of substance use among culturally and linguistically diverse communities provides a crucial foundational component in developing culturally sensitive prevention and treatment programs. These results demonstrate the need for programs to be tailored to the needs and contexts of particular communities, rather than treating those from diverse backgrounds as one homogenous group.