This paper provides a brief overview of harm reduction and individually focused alcohol prevention strategies. Universal, selective, and indicated prevention strategies are described for several populations including elementary and secondary schools, colleges, and medical settings. This paper primarily reviews individually focused alcohol prevention efforts in the United States (US), where harm reduction has been less well received in comparison to many European countries, Canada, and Australia. Zero-tolerance approaches continue to be the norm in individually focused prevention efforts in the US, especially amongst adolescents, despite research suggesting that harm reduction approaches can be effective. Moreover, existing evidence supports that harm reduction approaches show considerable promise in universal prevention and have become best practices in selective and indicated prevention contexts.