During the year 2004, 20% of eighth-graders and 60.3% of twelfth-graders reported that they had gotten drunk at least once over the course of just one year, according to the National Institute of Drug Abuse (NIDA). Of the 10.7 million underage youth who drink, 7.2 million or 31% of all high school students binge drink with a frequency of at least once a month. Complicating these figures with regard to just the area of teen drinking is the further finding that 21.5% of twelfth-graders had, at some point in their life, tried illicit drugs. Harder to capture in these survey results are the many related issues that misuse of alcohol and other drugs foster for teens: motor vehicle crashes, personal injury, sexual assault, teen pregnancy, vandalism, and impaired intellectual and social development. In this article, the author addresses underage drinking and drug use and discusses an integrated approach to prevent underage drinking and other drug use. He suggests that a set of coordinated, collaborative strategies and programs is required in each community for this problem to be dealt with effectively. Multiple component strategies that include two or more strategies together such as family and student programs or school prevention activities and community initiatives will have a greater impact than a single approach would have.