- Aim This study examines patterns of illicit drug use in a national sample of young men and women in Israel over a 20-year period. Design Annual cross-sectional data are analysed from an ongoing systematic sample of soldiers being discharged from active military service during the years 1982–2001. Setting An anonymous questionnaire is self-administered to soldiers on the day of discharge in an unsupervised setting. Participants Between 1200 and 2800 individuals participated in the survey annually. A total of 40 518 people were included in the analysis. This sample frame is reflective of all Israel Defense Forces (IDF) releasees below the rank of Captain. Military recruits in Israel comprised about 80% of the country's 18-year-old Jewish male cohort in any given year, and about two-thirds of the female population of this age. Findings Time-trends of drug use in Israel parallel those in the United States and European countries, although at much lower rates. Several indicators suggest a recent increase, particularly among women. Drug use is strongly inversely related to education level. Marijuana accounts for 65–75% of drug use in this young adult population. Conclusion Jewish cultural background and the military policy of zero tolerance are assumed contributors to the low drug use levels. Recent upward trends suggest that intensified prevention, surveillance and research efforts are in order.