Effective treatment and prevention programs could be implemented using three approaches. The reduction of the adverse medical consequences of substance abuse would be achieved through the development of innovative interventions in the social and physical environments; one possibility in this area is alcohol legalization. Community-based preventive education for reducing alcohol and drug misuse in the future would specifically foster life skills training to help Indian communities deal with early developmental problems that might lead to misuse. Finally, multifaceted rehabilitation programs would combine traditional tribal approaches and modern treatment strategies. 3 tables and 64 references (Author abstract modified)