Fighting back against America's public health enemy number one.

Fighting Back is a comprehensive substance abuse program operating in 14 communities spread throughout the United States. The Robert Wood Johnson Foundation has committed more than $45 million over a 7-year period to plan and implement innovative, community-wide initiatives in Columbia, SC; Charlotte, NC; Kansas City, Mo; Little Rock, Ark; Northwest New Mexico; Milwaukee, Wis; New Haven, Conn; Newark, NJ; Oakland, Calif; San Antonio, Tex; Santa Barbara, Calif; Vallejo, Calif; Washington, DC; and Worcester, Mass. In this article the work in progress at the end of 18 months of a 5-year implementation program in each site is reported. A Fighting Back National Program Office operates from a base at Vanderbilt University Medical Center in Nashville, Tenn. The senior staff of this office highlights the process that has unfolded to date, describes some of the sources of encouragement, and discusses some of the critical issues and sources of concern. A "Call to Action" on the part of the federal government is included.