Ethnic and cultural diversity are important determinants of alcohol and drug use patterns and consequences. Cultural differences constitute proximal determinants of alcoholism and imply certain differences in attitudes, values, and perceptual constructs as a result of different culturally based experiences. Thus, all children and adolescents are not equal clinically; transcultural communication is necessary for effective identification, diagnosis, and management of substance use disorders. Health status antecedents to, and consequences of, substance use disorders in ethnic groups of color are examined. Drinking is explored in biological, cultural, and social contexts.