Although alcohol and other drug use has declined among American Indian and Alaska native youth, Indian youth use drugs with greater frequency than non-Indians; this is particularly true for alcohol, marijuana, and inhalants. Few satisfactory explanations have been offered to account for the higher drug use rate among Indian youth, but factors such as poverty, prejudice, and lack of socioeconomic and educational opportunities play a role. The literature review focuses on programs with historical significance, pregnancy and early child care, youth in foster care, Indian boarding school and public school populations, community-based and residential programs for youth, cultural enhancement for youth in the community, programs in behavioral health clinics, and intervention program planning. With respect to the 16 demonstration programs, most employed primary prevention strategies and approaches; secondary-level strategies mainly incorporated assessment and referral, individual and group therapy, and self-help groups. Five of the 16 programs were comprehensive, providing primary, secondary, and tertiary intervention techniques. A telephone survey of the 16 programs indicated that poor self-esteem and parental alcoholism were the most significant risk factors in youth substance abuse. This survey also found that 63 percent of the programs were community-based, 87 percent targeted reservation communities, and all but one of the programs were based to some extent on aspects of the Indian culture. Appendixes provide further information on the demonstration programs and drug use prevention activities, as well as the telephone survey form. 92 references, 16 tables, and 2 figures