Begun in 1993, a 5-year project examined treatment modalities and outcomes and counselor and client attitudes related to American Indian or Alaska Native vocational rehabilitation (VR) clients with alcoholism or substance abuse problems. Specifically, surveys and focus groups examined elements of successful substance abuse treatment and VR programs, areas of social-cognitive dissonance between VR counselors and their clients, and the use of culturally relevant treatment modalities different from those used in mainstream programs. A 1993 survey of 31 "exemplary" substance abuse treatment centers recommended by VR counselors, and a 1996 followup survey of 14 of these centers found that most centers extensively incorporated American Indian personnel and cultural practices into the treatment process, but success rates over 50 percent were rare. In the followup survey, all programs based "most" or "some" of their treatment methodology on Alcoholics Anonymous (AA). Treatment orientations based on Native American traditional healing did not claim better success rates than other orientations. Counselor and client focus groups in Texas, New Mexico, and Arizona discussed eligibility for VR services, effects of the substance abuse problem and state of recovery on the VR process, client motivations, training needs, and factors contributing to or impeding recovery. Areas of congruence and disparity in counselor and client attitudes are discussed. Recommendations are presented for VR counselor training and program improvement, and the 12 steps of AA are listed. (SAS)