Tackling smoking has been recognised as key to reducing the burden of Indigenous cardiovascular disease. Alcohol's impact is less well recognised, but important. It contributes to sudden death, heart rhythm disorders, high blood pressure and heart muscle disease. But perhaps most importantly, problem drinking interferes with the ability of individuals, families and communities to manage their own health. In this presentation we briefly review what is known about patterns of smoking and drinking in Aboriginal and Torres Strait Islander Australians. We look at recent advances in management of alcohol dependence ('alcoholism'), including the role of relapse prevention medications. We also consider how counselling, group-based approaches and brief intervention can be adapted for an Aboriginal context. We examine approaches to tackling smoking in the clinical setting, including smoking cessation medications and brief intervention. We consider how modern, evidence-based treatment can be made more accessible to Indigenous Australians in an urban, rural or remote setting.