This study examined the problems of using conventional and traditional forms of psychotherapeutic and counseling interventions with American Indians and Alaska natives. Cultural specific forms of psychological and behavioral intervention and prevention have existed in Indian and Native communities for centuries. Vestiges of traditional healing and treatment ceremonies persist to this day although many have been revised to accommodate contemporary lifestyles. Numerous Indian and Native communities are working through a variety of prevention and intervention schemes in an effort to deal with drug and alcohol use. The communities rely heavily on the conventional wisdom and methods of the substance abuse research field; however, the community resource people recognize that intervention schemes must be adjusted to fit local tribal specific customs and norms. Cognitive-behavioral prevention, bicultural competence, and social skills enhancement perspectives were brought together to form a drug use prevention-intervention strategy tailored for use with Indian youth. As a stand alone prevention-intervention strategy the cognitive-behavioral perspective probably would not be very useful. The content of the components, exercises, interpersonal communication styles, and didactic approaches must be adjusted to fit the cultural lifeways of a community. Local people also must be included in the planning and curriculum adjustment and modification phase, and they should be trained to serve as group leaders. The cognitive-behavioral skills enhancement prevention strategy, therefore, can be used in many culturally different communities. (LLL)