This chapter reviews the literature on substance abuse and prevention efforts in Native communities. The first section describes demographic characteristics of America's indigenous people, including tribal and government definitions, interaction and validation styles, and rural-urban differences. It concludes by warning that use of broad ethnic glosses to describe any ethnic group in a research venture is poor science, and that research involving American Indians must consider the cultural variations and numerous subgroups that have distinct lifeways. The second section presents an overview of the substance use and misuse field, noting that the research on prevention is very limited. Topics covered include setting, rates and patterns of substance use, etiology and correlates of use, prevention, social skills, peers, family, school-based programs, policy, community-wide efforts, community readiness, and cultural sensitivity. Conclusions drawn include: the family is central in American Indian culture and must be involved in prevention approaches; peer influence is significant, but to a lesser degree than among non-Natives; cultural identification is not directly related to substance abuse prevention, although it may be critical in treatment; many factors affecting youth in general also impact drug use among American Indian youth; much more is known about risk than about resiliency factors for American Indian youth; and evidence of the effectiveness of school-based programs is very limited. Seven recommendations are given for the advancement of prevention strategies, themes, and research among American Indians and Alaska Natives. (Contains 72 references.) (TD)