This paper examines the social-historical lineages of adolescent alcohol and other drug (AOD) use prevention programs. It shows how risk factor research evolved from assumptions of deviance regarding the mentally ill and examines patterns in prevention research that have inhibited advancement in the field. These patterns take shape as: a general assumption of the target population as deviant, over- or mis-interpretation of research results, and evidence that researchers and program managers/administrators shift or initiate programs with no causative basis. For the field to move ahead, researchers, program specialists, and policy makers must reconsider these patterns in light of protective factor and harm-reduction approaches.