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Recent years have witnessed dramatic increases in attention to and funding of solutions for substance abuse problems. At the federal level, more resources have gone to interdiction and supply reduction rather than to substance abuse treatment or prevention. In San Francisco, substance abuse administrators increased the focus on demand reduction by organizing local resources, creatively seeking financial resources, and gathering community support. The federal reorganization of substance abuse programs presents a unique opportunity to widen the influence of treatment and prevention approaches. This article describes the impact of the Alcohol, Drug, and Mental Health Administration Reorganization Act of 1992 and the organization of the newly created Substance Abuse and Mental Health Services Administration.