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The societal costs due to alcohol and drug problems are staggering. Healthcare reform will create incentives for funding programs that prevent disabilities. Although evidence based practices has become a buzzword, there is still no consensus on what constitutes evidence; the challenge is to build a system based on current scientific evidence, which is conceptually sound and internally consistent. Aggressive efforts are needed to bridge gaps between practitioners, researchers and policymakers in order to expedite the implementation of evidence based practices. We can no longer afford to continue practices that are ineffective and therefore costly. Treatment providers currently have no incentive to change practices; they will continue to do business as usual unless an intervention takes place. Evidence based practices, collaborations, prevention, and dissemination of information will provide increased savings and the best care possible for all citizens.