The high prevalence of alcohol use and its consequences among American Indians may be attributed to a number of factors, including the influence of the European colonists who first made large amounts of alcohol available to Indians, as well as current social and cultural factors. Efforts to prevent and treat alcohol problems among the American Indian population may be more effective if native beliefs and approaches are incorporated. Alcohol problems also may be prevented through policies regulating the sale and use of alcohol in Indian communities. The article discusses: (1) the historical context of alcohol abuse in North American indigenous populations; (2) contemporary patterns of alcohol use; (3) consequences of alcohol use and abuse; (4) comorbidity of alcohol problems and mental disorders; and (5) causal explanations for alcohol abuse and alcoholism. References