The American Journal of Drug and Alcohol Abuse: Cultural adaptations of universal substance abuse prevention programs are emerging at a rapid pace, and nowhere is this proliferation more evident than among American Indian/Alaska Native (AIAN) communities. There is tremendous diversity in these culturally based programs. Some merely modify existing program language without revising content; others culturally interpret known key malleable constructs and add specific cultural content, and still others, usually grassroots programs, focus mostly on identified cultural protective factors. In this review we will attempt to address this diversity. We will review three categories of AIAN substance abuse prevention programs: (1) published empirical trials; (2) promising programs, published and unpublished, that are in the process of development and that have the potential for empirical trials; and (3) examples of innovative grassroots programs that originate at the local level and may have promise for further development. We chose to include some examples of these local, culturally based prevention programs because they are such vital elements of AIAN substance abuse prevention. Link to Journal Article