The individual who reaches age twenty-one without smoking, using illegal drugs, or abusing alcohol is virtually certain never to do so. As Joseph Califano points out in his searing indictment of America’s irresponsible attitude towards drug abuse, by failing to act on this lesson, we have lost untold lives and resources.

Califano deftly demonstrates how substance abuse is implicated in poverty, violent crime, soaring health care costs, family dissolution, child abuse, homelessness, teen pregnancy, and AIDS. With alcohol and tobacco interests buying political protection with campaign contributions and helping seed a culture of substance abuse, Califano illustrates the dire need for parental engagement, proposes revolutionary changes in prevention, treatment, and the nation’s criminal justice, health care, and social service systems, and sounds an urgent cry to address the plague responsible for the death of more Americans than all our wars, natural catastrophes, and traffic accidents combined.