A review of the magnitude of the problem of alcohol abuse among American Indians concludes that the "survival of Indian people today continues to be challenged by the abusive use of alcohol." A study of four alcohol-related causes of death in Oklahoma found, for example, that proportionately more Indians died from alcohol-related causes than Blacks or Whites (Dufour, Bertolucci, and Malin, 1985). Studies of Indian drinking patterns usually show a heavy and often binge-like mode of drinking, which is the type of drinking that leads to alcohol-related morbidity and death. Regarding the possibility of a genetic factor in alcoholism among American Indians, genetic studies are currently being conducted among Indian populations in both the United States and Canada. Currently, however, there is no firm research that has determined whether or not an "alcoholic gene" is present in individuals of Indian descent; therefore, prevention efforts must address other behaviors, beliefs, and practices distinctive within American-Indian communities, such as drinking at an early age, rapid consumption of alcohol, and general community acceptance of drunkenness. This paper discusses primary, secondary, and tertiary measures for preventing alcohol abuse by American Indians. Rational social, medical, and therapeutic approaches in planning and implementing community-based programs should begin to make inroads, with consistency in approach being the key. Various studies of Indian drug use other than alcohol indicate that Indians do not widely abuse some of the more commonly abused drugs in the general population. Abuse of inhalants, first reported in the late 1960s and early 1970s in the general population, now is apparently a phenomenon of a few Indian communities in the United States and Canada, usually among Indian youth. 5 tables, 87 references, and 4 notes