ABSTRACT: Harm Reduction is gaining acceptance in large urban centers in the United States as a practical alternative to traditional models of substance treatment. The reduction approach differs from traditional disease and moral/criminal models of substance and addiction by emphasizing harm reduction instead of use reduction. Harm reduction is comprised of pragmatic strategies that aim to reduce the harmful consequences of substance for both the individual user and the surrounding environment. The modality of music therapy is particularly well-suited to promote the goals of a reduction approach, as aspects of the music therapy process are naturally consistent with tenets of reduction. The purpose of this paper is to outline the origin, philosophy, and scope of the reduction movement, present a preliminary description of the of music therapy in reduction, and offer implications for music therapists working within this approach. Two contrasting and somewhat contradictory models of substance and addiction currently predominate within the United States: the moral/criminal model and the disease model. From the perspective of the moral/criminal model, substance is an act that is morally wrong and necessitates punishment. Intervention efforts are based upon reducing the supply of illegal drugs into this country, and imprisoning both drug dealers and users in order to eliminate drug in society. This approach has led to overcrowded prisons, high recidivism rates for drug offenders, and racist sentencing for drug related offenses (Brocato & Wagner, 2003; Marlatt, 1996). Conversely, the disease model of addiction views biological/genetic disease as the cause of prolonged drug use, and therefore treatment and rehabilitation of the individual are the focus for ameliorating drug problems. The disease of addiction is viewed as progressive in nature, and is considered lethal if not arrested, implying the need for total abstinence (Tatarsky, 2002). A drawback of the disease model is that it can strip the individual of any self-sufficiency in managing or modifying drug by insinuating a lack of personal control over behavior. Despite differing points of emphasis, the ultimate goal of each of these contrasting models is abstinence through reduction. Harm reduction offers a practical alternative to both of these approaches by shifting therapeutic focus away from the substance itself, and concentrating instead on the consequences of addictive and high-risk behavior. These consequences are evaluated as to their helpfulness or harmfulness to the individual and to the society at large (Marlatt, 1998), and modifications are made to reduce harm. The reduction approach acknowledges that the consequences of substance are as diverse as the underlying conditions that motivated that use. A potentially high-risk behavior such as substance may have a broad range of associated harms. The 2001 Household Survey found that 15.9 million people in the U.S. were using drugs at the time of the study, and that over half of those used marijuana alone (56%) (Substance Abuse and Mental Health Services Administration, 2002). The harmful potential of substance for these nearly 1 6 million Americans spans a very broad range from minimal social or criminal repercussions to major life-threatening health risks. These harms may be viewed as a continuum, with the goal of reduction being to move along the continuum in the direction of decreasing harm. Harm reduction also views substance itself as a continuum of possible behaviors, not a progressive condition as purported by the disease model. This continuum of substance includes nonuse (abstinence), use, abuse, addiction, and persistent addiction; and progression from to dependence is not inevitable (Denning, 2000). The belief that substance is not necessarily progressive in nature is an important distinction of the reduction approach. …