Over 19 percent of teenage American Indians use illicit drugs--the highest rate of any group in the country. The potential consequences of alcohol and/or drug abuse on Indian adolescents include higher involvement with the juvenile justice system, increased mental health problems, and lower educational achievement. Cultural competence is defined as a combination of cultural knowledge, social skills, and personal attitudes. The five patterns of cultural adaptation proposed for understanding bicultural functioning are assimilation, acculturation, alternation, multiculturalism, and fusion. Many American Indian/Alaskan Native (AI/AN) people function in a bicultural pattern. Since 1989, Our Youth Our Future, Inc. (OYOF), a nonprofit organization, has been providing services for AI/AN adolescents. The program has evolved from a 12-step program and adventure-based or recreational model of treatment into a bicultural treatment model. The model takes as its premise that the acculturation of many AI/AN adolescents into their ancestral heritage has been incomplete or disrupted. It is designed to promote the successful development of bicultural skills that will allow the individual to alternate behavior according to the cultural situation, and to develop a firm identity in their native culture. OYOF provides a battery of general and culturally specific assessments before admission to determine the appropriate level of care and treatment. Youth are assigned to one of three treatment tracks: the adventure base-counseling track (Air Group), the emotional management track (Water Group), and the general management track (Earth Group). Surveys suggest that 6 months after discharge the treatment effect begins to dissolve and at 12 months has disappeared. There are minimal to no appropriate aftercare services available to the discharged adolescents in their communities. However, the implementation of a bicultural competent treatment approach supports the successful completion of treatment, improves family participation in treatment, and increases cultural identity. 69 references