Alternative drug policies are needed in which harm reduction is integrated as the underlying logic, particularly since the drug problem involves various harms. These harms include crime and violence, the development of a large criminal economy, school dropouts, mortality, and strains on U.S. foreign policy. Drugs also have many adverse effects on health, and intravenous drug use promotes the spread of AIDS. Harm reduction approaches have been implemented in Europe but have not been rigorously evaluated, with the exception of needle exchange programs. These approaches encompass methadone maintenance, decriminalization, and legalization. The United States, however, has resisted harm reduction strategies due in part to bureaucratic and political factors. An integrated approach to harm reduction is recommended, and the harm reduction concept is applied to smoking. 25 references and 1 figure