The four communities are Vallejo, CA; Santa Barbara, CA; Little Rock, AR; and Gloucester, MA. This paper identifies and examines some of the common elements of the programs these communities have integrated into their existing health care systems. All of the programs share five elements essential for success: strong leadership; a "vision" or blueprint for change; sufficient financial resources; a strong network of groups with different interests; and a lead agency that guides the efforts of many groups working toward a common goal. The program in Vallejo, CA, found that outpatient substance abuse treatment is cost-effective; partnerships between a health care provider and a community group can facilitate innovative systemic changes in health service; and managed care organizations can provide cost-effective substance abuse services to the Medicaid and other populations. The program in Santa Barbara, CA, discovered that the hospital emergency room is a good place to identify and refer people who need help with substance abuse; hospitals can benefit through greater referrals to their own programs; a trained substance abuse specialist is a great asset for training hospital staff and building a local community service infrastructure; and hospital personnel must receive continuing training. The Little Rock program determined that outpatient treatment programs can reduce substance abuse for children; community partnerships can build support for broad-based designated tax support for treatment and prevention programs; and a well-informed referral network is key to getting people to the right treatment services. Among the lessons learned by the Gloucester program is that community partnerships can change community norms on substance abuse by using existing networks of citizens working on other issues. A list of 7 annotated resources