The substance abuse prevention field is at a crossroads. In this time of healthcare reform, the opportunity exists to combat substance abuse and related harms with concerted, community-based and comprehensive efforts to change norms, behaviors, systems and contexts that contribute to substance abuse problems in our communities. The purpose of this paper is to discuss how a truly comprehensive response to
substance use and abuse in our country can be implemented. Specifically, this response includes BOTH environmental/policy efforts and individually-focused prevention efforts in order to reduce substance abuse population-wide. Furthermore, it is critical to recognize the invaluable role local, community-based coalitions play in implementing a comprehensive array of evidence-based strategies to reduce underage drinking, tobacco use and illicit drug use. Coalitions have had great success at choosing and implementing the right combination of strategies to address local conditions contributing to substance use and abuse in their communities. Continued efforts are needed to support the role coalitions play in creating safe, healthy and drug-free communities.