Fifty urban American Indians were interviewed during admission to a free-standing medical detoxification unit. From the year before the interview through 2 years of follow-up, this sample averaged 44.6 detoxification admissions and 64.1 days in other inpatient treatment and had no significant change in the number of annual detoxification admissions. At follow-up all but three subjects reported recent alcohol dependence symptoms or episodic alcohol abuse. these patients continued to experience serious alcohol-related problems despite repeated treatment in both medical detoxification and inpatient rehabilitation settings. These findings emphasize the need for more innovative and effective alternatives to the existing revolving door process.