Demographic information indicates that 6% of the general population is hard of hearing or deaf; however, deaf people are significantly underrepresented in drug and alcohol treatment on any given day. Deaf people are a minority whose primary language is American Sign Language (ASL), and information about substance abuse is not easily represented in that language. Communication difficulties encountered by deaf and hard of hearing people, including difficulties in their own families, are discussed. Risk factors of isolation and stress are considered. Besides being isolated by chemical dependency, deaf individuals may be isolated by their language use and not have access to resources that could help them. Often translators are not available for assessment procedures or for treatment, and mainstreaming approaches are unsuccessful without translators. A model program is described using drawing for treatment assignments, with videotaped materials using sign language, voice, and captioning. The program also provides assistive listening devices, TTY access, flashing light signals, and decoders. Follow-up findings and obstacles to recovery and treatment among the deaf are discussed. Factors that increase the probability of success in treatment are listed. (EMK)