OBJECTIVES: Limited empirical evidence exists on smoking, alcohol consumption, nicotine dependence and alcohol abuse over time. This study examined the trend of smoking and alcohol use in 2006-2016 in the United States. METHODS: Patients≥18 years old were extracted from the IBM Watson Health linked Claims and Explorys Database (CED) in 10/1/2006-9/30/2016. CED contains diagnosis codes from MarketScan claims Databases and patient reported outcomes (PRO) from Explorys electronic medical records. The smoking cohort included patients who answered questions on tobacco use. The alcohol cohort included patents who answered questions on alcohol consumption. Patients self-identified as smokers or alcohol users were defined using PRO. Nicotine dependence and alcohol intoxication/abuse/dependence were defined using diagnosis codes. The study window was 10 annual time periods from 10/1/2006-9/30/2007 to 10/1/2015-9/30/2016. RESULTS: The smoking cohort included 1,275,429 patients (mean age: 47.9 years; 56.2% female); 37.8% of them reported using or previously used tobacco while 11.0% received a diagnosis of tobacco dependence any time during the whole study period. The alcohol cohort had 886,411 patients (mean age: 47.6; 56.4% females); 59.6% reported alcohol consumption and 1.5% received an alcohol intoxication/abuse/dependence diagnosis. The rates of self-reported tobacco and alcohol consumption were relatively stable over time: smoking rates ranged from 30.8% (10/2007-9/2008) to 38.9% (10/2011-9/2012); alcohol rates were between 53.5% (10/2006-9/2007) and 57.9% (10/2008-9/2009). The proportion of patients being diagnosed as nicotine dependence and alcohol intoxication/abuse/dependence consistently increased across years. Nicotine dependence went up from 1.3% in 10/2006-9/2007 to 7.6% in 10/2015-9/2016 and alcohol abuse went up from 0.3% in 10/2006-9/2007 and 10/2007-9/2008 to 0.9% in 10/2015-9/2016. CONCLUSIONS: Although the rates of self-reported smoking and alcohol assumption were stable over time, the rates of diagnosed smoking and alcohol dependence have increased from 2006 to 2016. More research is needed to accurately measure smoking and alcohol use and dependence.