This chapter places archival work from the William J. Clinton archives within the context of long-term American attitudes toward intoxication in order to explain the different reception of ‘harm reduction’ as drug treatment and policy in Europe and the United States. It argues that drug policy has, since at least the early 1970s, been caught in the crossfire of a so-called ‘culture war’ where conservative republicans have been able to define and re-deploy controversial fears of intoxication that have been contested for over 200 years. The result is that even allegedly ‘liberal’ politicians who seemed to favour harm-reduction have had to back off of this approach. This has not been the case in Europe where, despite the lack of a specific Maastricht protocol, harm-reduction seems to have carried the day across much of the continent. This chapter plays an important comparative role in a book that examines drug policy and treatment from a global perspective.