This article focuses on the erosion of alcohol management policies and the implications for local prevention efforts. It draws lessons from three large-scale multi-year multi-site programs in Canada, e.g., local addiction prevention projects, heart health programs, and tobacco control experiences. It explores five themes: getting alcohol on the agenda and implementing effective local responses to alcohol problems; assessing conceptual frameworks in order to identify the essential components of an effective prevention strategy; developing a system of local prevention initiatives that give priority to long-lasting structural changes; generating accurate information on alcohol-related damage in order to set priorities; and developing a prevention action plan in order to support local initiatives.