Substance abuse continues to be a family problem in American Indian (AI) families. This article highlights findings from a two generation study on substance abuse among nine AI families. Five common themes shared by the parent and adult child groups included early onset of substance abuse, minimization of substance abuse (and a subtheme of efforts to control use), taking accountability for substance abuse (and a subtheme about perpetuated stereotypes), turning point moments in use (and a subtheme of negotiating and exploring sobriety), and perceptions of the abstinence only approach. Clinical implications are discussed in light of the findings.