The nation's health system does not generally recognize and treat addiction, although nearly one in 10 Americans over the age of 12 has a problem with alcohol or drugs—some 22 million people in all. This chapter offers an inside look at strategies used by the Robert Wood Johnson Foundation (RWJF) to reduce the harm caused by alcohol and drug abuse in America. It traces the involvement of the Foundation in addiction issues and evolution of its approach over time. The author, a senior program officer at RWJF, observes that recent biological and neurological research has influenced the Foundation to approach addiction as a chronic health condition. Over the long run, the Foundation is looking toward an approach to treating alcohol and drug addiction that is based on a widely accepted model for treating chronic illness. The five core components of that model are discussed in the chapter.