The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
A bipartisan group of state health policymakers from both the executive and legislative branches who are focused on improving population health.
Networks of state officials, advocates, and others aiming to invest in and transform primary care.
A program dedicated to advancing state-based efforts to make health care more affordable for residents, employers, and states.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
A leadership development program for early and mid-career state government officials who are committed to improving the health of all people in their communities.
A leadership program for senior state government officials who are committed to improving population health.
The Fund focuses on creating an affordable health care system built on strong primary care and partnerships that improve health outcomes for all.
Improving state leaders’ ability to enact and implement evidence-based health policies.
Advancing policies that create a more prevention- and primary care-oriented health system.
Improving population health through policies that contain health care cost growth.
Our state health policy resources offer relevant data analysis and best practices.
The Fund publishes reports, issues briefs, and case studies on state health policy issues.
Short takes on health policy issues from Milbank staff and guest authors.
Insights from Milbank President Debra Lubar on state health policymaking.
Reported articles and Q&As on timely health policy issues, as well as foundation updates.
Milbank Memorial Fund and Milbank Quarterly webinars featuring state health policymakers and researchers.
Updates and expert contact information for reporters.
The Milbank Memorial Fund is a private foundation that works to improve population health and health equity.
March 2013 (Volume 91)
Quarterly Article
Grischa Metlay
Sep 25, 2026
Sep 23, 2026
Sep 22, 2026
Back to The Milbank Quarterly
Context: The formation of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Special Action Office for Drug Abuse Prevention (SAODAP) in the early 1970s dramatically expanded scientific and medical efforts to control alcoholism and drug abuse in the United States.
Methods: Drawing on a variety of primary, secondary, and archival sources, this article describes the creation and early years of these agencies.
Findings: I show that while the agencies appeared at roughly the same time, their creation involved separate sets of issues and actors. In addition, I show that SAODAP received more money and resources, even though advocates for alcoholics mobilized a stronger lobbying campaign.
Conclusions: Two factors explain this discrepancy in money and resources: (1) alcoholism was framed as a public health problem, whereas drug abuse was drawn into broader debates about crime and social decline; and (2) alcohol programs relied on congressional support, whereas drug programs found champions at high levels of the Nixon administration. These political and cultural factors help explain why current programs for illegal drugs receive more federal support, despite alcohol’s greater public health burden.
Author(s): Grischa Metlay
Keywords: alcoholism, drug abuse, substance abuse, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, Special Action Office for Drug Abuse Prevention, policy history
Read on Wiley Online Library
Volume 91, Issue 1 (pages 123–162) DOI: 10.1111/milq.12004 Published in 2013