The historical conflicts between Indian and white ways of life are still not completely resolved, and there are major differences among policymakers as to whether tribes should be assimilated into the larger culture or allowed to pursue the traditional Indian culture. In its ambivalence toward American Indians, the Federal Government has fostered a state of dependency that has made problem resolution difficult. Currently, there is a strong activist climate on Indian reservations that supports self-determination. Within this historical and cultural context, drug and alcohol abuse are major problems among Native Americans. Data identify alcoholism as the number one health problem for many tribes. The consequences of drug abuse are not as well documented, but recent survey data from Indian school students indicate that drug-use rates among Indians are above national norms and are apparently increasing rapidly. Interventions to deal with the drug and alcohol abuse problems must be congruent with the current movement toward self-determination. Externally imposed interventions will not work and will probably add to the sense of failure experienced by Indian people. If community spirit can be bolstered and hope developed through communal action and mutual support, solutions to abuse problems will emerge. A stepwise process can be used to foster a grassroots involvement of concerned citizens. These efforts will gradually expand into a major movement within the reservation community that will ultimately encompass the diverse and often fragmented elements of the helping professions. 2 tables, 1 figure, and 47 references