This chapter traces the history of drug and alcohol use in America, starting in the 1850s through Prohibition, the emergence of Alcoholics Anonymous in 1935, and the treatment evolution around the 1950s. It reviews the US Drug Policy in the 1970s, the rise of the “designated driver” movement in the 1980s. There were 52,000 deaths due to overdose in 2015 with 33,000 of these attributed to opiates. The addiction-recovery business is now a $35 billion industry; yet there is still an access-to-care issue. Finally, this chapter examines the shift in medical culture to include risk evaluation and mitigation strategies, mandatory training in addiction and pain management, and the American College of Graduate Medical Education (ACGME) recognized medical specialty, addiction medicine. It presents the six different domains to best assess what intervention or treatment program is likely to help the patient and concludes that more money needs to be directed at mental health and addiction recovery programs.