The authors examined the rate of and factors associated with alcohol abuse among 754 urban American Indian and Alaska Native primary care patients. Data were collected through a self-administered survey and by abstracting medical records. A total of 423 respondents (56 percent) screened positive for lifetime alcohol abuse, and 202 (27 percent) reported current alcohol abuse. A diagnosis of alcohol abuse was found in the medical records of 68 of the patients who screened positive (16 percent). Logistic regression analysis showed that being male, having been a victim of violence, and feeling depressed were associated with alcohol abuse. Further research is warranted to help clinicians detect and treat alcohol abuse in this special population.