The past emphasis on drug-use reduction has been inadequate. Total harm derived from drug use can be viewed as the product of use and harm per use. Thus, reducing drug use usually leads to a reduction in the harm caused by it; however, in some cases, use- reduction programs may increase the harm per use so much that they increase overall harm, even as they succeed in reducing drug use. Hence, use-reduction goals can be usefully augmented with the objective of reducing the total harm caused by the production, distribution, consumption, and control of drugs. Based on this perspective, an augmented Office of National Drug Control Policy should be responsible for coordinating Federal policy toward alcohol and nicotine as part of the overall national drug control strategy. Alcohol and nicotine account for the vast majority of drug-related negative health outcomes and economic costs, as well as for a large part of the drug-related dangers faced by juveniles. The integration of all efforts to reduce the harm caused by drug use will help ensure that for illicit drugs the public will be alerted to the distinction between use and harm. Secondary prevention is underused in current drug policy; yet it is a low-cost intervention that can have significant results. Drug enforcement at all levels should focus on harm-reduction goals. The priority of treatment and prevention should be increased within the health and education budgets and lowered within the enforcement budget. 24 references