Using data about members of a midwestern American Indian reservation in eight focus groups that were conducted like "talking circles," the authors describe the participants' (N = 49) views of the current use and abuse of tobacco, alcohol, and other drugs. Results indicate that the use of tobacco is pervasive; that the use of alcohol and other drugs, especially marijuana and oxycodone, are problems on this reservation because they are detrimental to health and well-being; and appropriate, available, and accessible treatment is scarce, nonexistent, or underfunded. Culturally sensitive substance abuse treatment and increased funding for treatment are major health issues for this population.