Information about and understanding of Native Hawaiian substance abuse and utilization of substance abuse treatment services is limited. This article reviews the literature on the prevalence and factors associated with substance abuse and use of health services among Native Hawaiian women in the U.S. The literature review included three review and 13 nonreview articles that were published through December 2006. The majority of the articles reviewed did not present findings by gender-ethnic group. The review of the literature suggested a high prevalence of substance abuse, especially among those who were incarcerated. Risk factors for substance abuse included not being married and young age.Native Hawaiian women also had significantly lower health care utilization rates compared to other groups, and were less likely to have seen a health care provider in the past year. Programs should consider involving Kupunas ("elders") in the design and implementation of culturally appropriate programs in order to better serve the needs of Native Hawaiian women. Further research is needed about the rates of substance abuse and barriers and facilitators to treatment so that effective and culturally competent treatment can be provided for this population.