American Indians experience many problems related to alcohol misuse. However, there are prevention approaches that work to reduce risk of alcohol misuse among American Indians. With regard to the way prevention workers carry out their work in American Indian communities, programs must emerge from the community, prevention workers must demonstrate a commitment to the community, and non-community members need to develop cultural sensitivity. Developing cultural sensitivity involves first becoming aware of one's own cultural values and learning about differences relative to other cultures, and then spending time in a community. When negotiating program access with American Indian communities, it is important to demonstrate how the community will benefit from the program. Regarding prevention approaches that are most appropriate in American Indian communities, several principles emerge: using American Indians as staff whenever possible, and incorporating cultural concepts within the programs. Because American Indian culture varies across communities, it is important to design programs that are relevant to local norms, values, and conditions. Prevention programs should empower people by enabling participants to identify with and function in their community and the dominant society, and by assuring that individuals in the community can continue the programs. A comprehensive community program should involve a variety of approaches that fit together in a mutually supportive and beneficial manner and strengthen the community and family, not just individuals. Finally, programs must ensure that the interventions are adequate and maintain fidelity across sites. (Contains 95 references.) (TD)