Many of the studies reviewed reported a significant co-occurrence of alcohol/other drug abuse/dependence with affective and disruptive disorders, particularly attention-deficit hyperactivity disorder, conduct disorder, and oppositional defiance. Among the community-based adolescent studies, a majority reported the co-occurrence of substance use disorders with both mood and disruptive behavior disorders. Alcohol was the most commonly identified substance of abuse in most of the studies. Most of the studies also noted the lack of treatment services used even when services were readily available and at no cost. Among the residential treatment (clinical) population, there was a significant co-occurrence of psychiatric disorders and psychiatric symptoms, yet few of these adolescents had sought prior mental health treatment. The findings of the literature review suggest that treatment programs for youth should consider the close association of alcohol/drug disorders and psychiatric disorders and should carefully screen for both sets of disorders. The literature review focused on both the community and treatment (clinical) adolescent population. Research literature was identified through searches on Medline, PsychINFO, and the Native Health Research Database at the University of New Mexico Health Sciences Center Library. All articles reviewed were published between 1966 and 2005 and addressed comorbid substance abuse and psychiatric disorders or psychiatric symptoms in adolescent American Indians and Alaska Natives. Future research should investigate the co-occurrence of disorders among other tribal communities. Tables, references