Objective:This systematic review assessed the feasibility of American Indian traditional ceremonial practices (TCPs) to address problem substance use in both reservation and urban settings.Methods:Between September 24, 2021, and January 14, 2022, culturally specific review protocols were applied to articles retrieved from over 160 electronic databases—including PubMed, Global Health, Global Health Archive, CINAHL Complete, PsychInfo, Web of Science, Health and Wellness (Gale), Sage Online Journals, and ScienceDirect.Results:A total of 10 studies met the criteria for inclusion in the review. Studies were conducted with both urban (n= 7) and reservation (n= 3) American Indian and Alaska Native (AIAN) populations. The most common TCP activities reported were drumming (n= 9), sweat lodge (n= 7), and talking circles (n= 6). All 10 studies reported some type of quantitative data showing a reduction of substance use associated with TCP interventions or activities.Conclusions:The current status of the literature is emerging and does not allow for meta-analysis of existing studies. However, the existing literature does indicate promise for the use of TCPs to address problem substance use in AIAN communities in a way that is effective and also culturally congruent.