Alcohol is the most frequently used drug among young Americans. In 2003, some 75 percent of high school students had experimented with alcohol, compared to 58 percent who had tried cigarettes and 53 percent who had tried an illegal drug (including marijuana and cocaine). The Robert Wood Johnson Foundation began, in the early 1990s, to address the harm caused by underage drinking, first by financing a survey of alcohol use and abuse in colleges and then by funding a series of programs aimed at reducing drinking for students from elementary school age through university level. This chapter looks in detail at the history and rationale of two RWJF programs: A Matter of Degree: Reducing High-Risk Drinking Among College Students and Reducing Underage Drinking through Coalitions. The author discusses how the programs operate in practice and the early findings from evaluations. Despite the serious health problems associated with binge and underage drinking, the author discusses some of the reasons why its consequences are not widely appreciated. The chapter concludes with a description of lessons learned based on site visits and interviews with national experts, program evaluators and program participants.