The development and psychometric properties of a brief screening tool for use with American Indian youth suspected of abusing substances is described. The Indian Health Service-Personal Experience Screening Questionnaire (IHS-PESQ) is a brief questionnaire that screens for drug abuse problem severity, response distortion tendencies, and psychosocial risk factors. The psychometric properties of the problem severity scale are favorable when tested in reservation-based American Indian students (grades 6-12). The paper also describes the role of the IHS-PESQ within a prevention, intervention and treatment referral system designed for American Indian youth.