Native Americans have experienced substantial problems with alcohol since its introduction to their culture by early European settlers. Epidemiological data indicate that elevated morbidity and mortality attributable to alcohol abuse among this population remain at epidemic levels. Adolescent drinking patterns and family and peer influences on alcohol use are examined. A multifactorial etiology is indicated in the origin of Native American alcohol abuse. Some scholars have ascribed this problem to historical factors such as the introduction of alcohol to Native Americans by aberrant role models, while other researchers subscribe to various physiological theories which support the "firewater myth" suggesting that Native Americans may be genetically predisposed to crave ever increasing doses of alcohol during a rapid loss of control of their senses. The physiological theories generally suggest significant differences in alcohol absorption and metabolism rates between Native Americans and caucasians. A wide variety of social factors appear to be implicated in Native American drinking problems. Cultural and social orientations, socioeconomic conditions, "stake theory," failure to develop social sanctions regulating drunken deportment, passive-aggressive syndromes, and emotional repression contribute to Native American alcohol abuse. Treatment regimes for Native American alcoholics are examined briefly. Nativistic movements, conversion to evangelistic regions, therapies grounded in the medical model, and Native American group-oriented efforts have demonstrated varying degrees of success. Clearly, prevention would be preferable to the frustration of attempting to change the highly addictive behavior patterns characteristic of alcoholism. Suggestions for health education interventions are presented including an example of one effort currently being implemented.