INTRODUCTION Fetal Alcohol Syndrome (FAS) has been reported in people of all racial identities. FAS is not an Indian problem per se; it is an alcohol problem. It is an Indian problem only to the extent that Indians have alcohol problems. FAS is a major public health problem in cultures that have problems with alcohol abuse. Many American Indian/Alaska Native communities have disproportionately high rates of FAS, both on and off reservations, both among children raised in their natural environments and those who have been adopted away and raised out of their communities. FAS is not caused by the environment in which a child is raised after birth, but by the toxic effects of alcohol prior to birth. It has been proposed that cultural, social, environmental, and biological factors may interact to increase the risk of FAS among American Indians/Alaska Natives. This paper focuses on what Indian communities can do to understand and prevent this disabling condition and to help the lives of those affected.