Restaurant workers in the United States exhibit high levels of alcohol and drug use. However, there is a scant amount of qualitative research uncovering how and why restaurant employees use and abuse legal and illegal substances. Examining restaurant workers’ self-reported risky health behaviors is important for improving employee and occupational quality of life. The purpose of this article is to investigate the health behaviors of restaurant workers and pathways to such outcomes. Specifically, this article explores the question of what social conditions and processes within restaurants relate to employee adverse health behaviors. Drawing on qualitative data collected between 2009 and 2014, this article focuses on a case study of restaurant employees, detailing their substance use and the ways in which they discuss and talk about taking health risks. An analysis of 52 in-depth, semistructured interviews with restaurant workers broadens the theoretical explanation for deviant health behaviors in the service sector. Results indicate that workplace characteristics—such as occupational socialization, norms and values, job stress and coping mechanisms, social networks and friendships, and personnel policies—permit and encourage substance use and risky health behaviors. Research implications include underscoring service industry adverse health behaviors and recommendations for positive social change in terms of personal, social, and job-related well-being.